嗜麦芽窄食单胞菌血流感染的临床特征分析

发布时间：2018-05-30 22:35

  本文选题：嗜麦芽窄食单胞菌 + 血流感染　； 参考：《浙江大学》2017年硕士论文

【摘要】：目的:探讨嗜麦芽窄食单胞菌血流感染的临床特点、治疗方案和预后,为临床嗜麦芽窄食单胞菌血流感染防治提供有力证据。方法:对浙江大学医学院附属第一医院2012年1月至2015年8月诊断为嗜麦芽窄食单胞菌血流感染的住院患者的临床资料进行回顾性分析,且进行临床特征相关性分析以及logistics回归分析。结果:54例嗜麦芽窄食单胞菌血流感染患者平均年龄50.5岁,检出前平均住院16天。17例(31%)合并有其他细菌感染,43例(80%)合并其他系统感染,其中合并肺部感染最常见(32例,占59.3%)。嗜麦芽窄食单胞菌血流感染多发生于恶性实体肿瘤、血液病患者(各占29.6%),最常见于肝胆外科(25.9%)等科室,37例患者存在中心静脉置管(68.5%)。在血培养嗜麦芽窄食单胞菌阳性前,54例患者中52例使用了抗菌药物;在血培养阳性后,54例患者均使用了抗菌药物,其中有42例调整了抗菌药物。治疗药物主要是β-内酰胺酶抑制剂复合制剂29例(53.7%),喹诺酮类11例。54例患者好转32例(59%),死亡22例(41%);好转组 APACHEII 评分(14.13±4.54)、死亡组 APACHEII 评分(27.59±8.17),两组有统计学差异(P0.05)。合并其他部位感染、有中心静脉置管、高APACHEII评分组死亡率更高(P0.05),而血培养阳性后拔除中心静脉管,使用敏感抗生素组死亡率更低(P0.05)。相关性分析显示APACHEII评分、检出前住院时间、CRP水平、有中心静脉置管及合并器官感染与嗜麦芽窄食单胞菌血流感染预后呈现明显负相关(P0.05),血培养阳性后拔除中心静脉置管、使用敏感抗生素与嗜麦芽窄食单胞菌血流感染患者预后的保护性因素(P0.05)。进一步进行多元二分类logistics回归分析发现中心静脉置管与嗜麦芽窄食单胞菌血流感染预后呈负相关(OR值为174.461,P0.05),拔除中心静脉置管与嗜麦芽窄食单胞菌血流感染预后呈正相关(OR值为0.018,P0.05)。结论:嗜麦芽窄食单胞菌血流感染多见于免疫力低下的危重患者,多发生在院内外科手术操作的科室,多伴有中心静脉置管,且容易合并其他部位感染。目前嗜麦芽窄食单胞菌血流感染预后一般,APACHEII评分高,嗜麦芽窄食单胞菌血培养检出前住院时间长、多合并其他部位感染以有炎症表现的患者病死率更高,预后差。而血培养阳性后拔除中心静脉置管、及时使用敏感抗菌药物可改善嗜麦芽窄食单胞菌血流感染患者的预后良好。尤其影响嗜麦芽窄食单胞菌血流感染预后的危险因素为中心静脉置管,保护因素为拔除中心静脉置管。这提示临床防治麦芽窄食单胞菌血流感染的一个重要措施应减少中心静脉置管的手术操作,以切断嗜麦芽窄食单胞菌血流感染的途径。
[Abstract]:Objective: to investigate the clinical features, treatment and prognosis of Stenotrophomonas maltophilia infection, and to provide evidence for the prevention and treatment of Stenotrophomonas maltophilia blood flow infection. Methods: the clinical data of hospitalized patients diagnosed as Stenotrophomonas maltophilia from January 2012 to August 2015 in the first affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. The correlation analysis of clinical features and logistics regression analysis were carried out. Results the average age of 54 patients with blood stream infection of T. maltophilia was 50.5 years old. The average hospital stay before detection was 16 days. 17 patients were admitted to hospital for 16 days. There were 43 patients with other bacterial infection and 80 patients with other systemic infection. Among them, 32 cases were complicated with pulmonary infection, accounting for 59.3%. Stenotrophomonas maltophilia blood flow infection mostly occurred in malignant solid tumors. In 37 patients with hematologic diseases (29.6m, 25.9%, respectively), central venous catheterization was found in 37 patients. Antibiotics were used in 52 of 54 patients who were positive for Stenotrophomonas maltophilia in blood culture, and in 54 patients after positive blood culture, 42 of them adjusted antibiotics. The main therapeutic drugs were 尾 -lactamase inhibitor compound preparation (29 cases, 53.7%), quinolones (11 cases, 54 cases), improvement (32 cases), death (22 cases), APACHEII score (14.13 卤4.54), APACHEII score (27.59 卤8.17) in the death group, there was statistical difference between the two groups (P 0.05). In the group of high APACHEII score, the mortality rate was higher than that in the group with high APACHEII score, but the central venous tube was removed after positive blood culture, and the mortality rate in the group of sensitive antibiotics was lower than that in the group of sensitive antibiotics. Correlation analysis showed that APACHEII score, hospitalization time before detection, central venous catheterization and complicated organ infection were negatively correlated with the prognosis of Stenomonas maltophilia blood stream infection (P 0.05), and central vein catheterization was removed after positive blood culture. Protective factors of prognosis in patients with Stenotrophomonas maltophilia and sensitive antibiotics. Further multivariate binary logistics regression analysis showed that there was a negative correlation between central venous catheterization and the prognosis of Stenotrophomonas maltophilia blood stream infection. The OR value was 174.461 (P 0.05), and the OR value was 0. 018% (P 0. 05) when the central venous catheter was pulled out and the prognosis of the blood stream infection of Stenomonas maltophilia was positively correlated. Conclusion: the infection of Stenotrophomonas maltophilia is more common in the critically ill patients with low immunity. It often occurs in the department of surgical operation in the hospital, and it is often accompanied by central venous catheterization, and it is easy to be complicated with infection in other parts. At present, the prognosis of Stenotrophomonas maltophilia blood stream infection is generally higher than that of APACHEII score, the hospitalization time is long before the blood culture of Stenotrophomonas maltophilia is detected, and the mortality of patients with inflammation is higher and the prognosis is poor. The positive blood culture can improve the prognosis of patients with blood stream infection by removing central venous catheter and using sensitive antibiotics in time. In particular, the risk factors affecting the prognosis of Stenotrophomonas maltophilia were central venous catheterization, and protective factors were extubation of central venous catheterization. It is suggested that an important measure to prevent and treat the infection of Stenotrophomonas maltophilia is to reduce the operation of central venous catheterization in order to cut off the route of blood stream infection of Stenomonas maltophilia.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R515
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本文编号：1957126