复数菌与单菌血流感染患者临床特征及预后影响因素

Clinical characteristics and impact factors of prognostic factors of patients with blood stream infection caused by multi-bacteria and mono-bacteria

摘要:

目的 调查复数菌与单菌血流感染患者的临床特征及预后的影响因素。 方法 回顾性分析某三甲医院2017年1月-2021年12月临床和病原学确诊的血流感染患者的病历资料, 依据检出病原菌种数分为单菌组和复数菌组, 研究结局为住院期间全因死亡率。比较两组患者的临床特征及复数菌患者预后的影响因素。 结果 共有430例患者血培养阳性。单菌血流感染367例(85.3%), 复数菌血流感染63例(14.7%)。复数菌组患者医院感染所占比率较单菌组高(76.2% VS 56.9%), 差异有统计学意义(P=0.003);复数菌组患者下呼吸道感染比率较单菌组高(44.4% VS 29.2%), 差异有统计学意义(P=0.018)。复数菌组患者住院时间较单菌组高[24(16~39) VS 19(13~26) d], 差异有统计学意义(P=0.002)。复数菌组患者病死率高于单菌组(12.7% VS 3.8%), 且住院时间延长, 差异均有统计学意义(均P < 0.05)。多因素分析显示, 复数菌感染(OR=3.24, 95%CI: 1.20~8.75)、消化道肿瘤(OR=3.28, 95%CI=1.21~8.84)、有创机械通气(OR=3.40, 95%CI=1.22~9.42)、深静脉置管(OR=2.76, 95%CI=1.00~7.64)、留置导尿管(OR=3.28, 95%CI=1.04~10.40)是血流感染患者死亡的独立危险因素。相较于单菌组, 复数菌组送检时间至出院时间间隔显著延长[20(15~36) d VS 16(10~22) d, P < 0.001]。单菌组与复数菌组患者检出的金黄色葡萄球菌、溶血葡萄球菌和大肠埃希菌的构成比较, 差异均有统计学意义(均P < 0.05)。 结论 住院患者复数菌血流感染死亡风险显著增加, 消化道肿瘤、有创机械通气、深静脉置管、留置导尿管是血流感染患者死亡的独立危险因素, 应引起临床的重要关注。

Abstract:

Objective To investigate the clinical characteristics and impact factors for prognosis of patents with multi-bacteria and mono-bacteria blood stream infection (BSI). Methods Medical records of patients with clinical and pathogenic diagnosis of BSI in a tertiary first-class hospital from January 2017 to December 2021 were retrospectively analyzed.According to the detected species of pathogenic bacteria, patients were divided into multi-bacteria and mono-bacteria groups, the study outcome was all-cause mortality during hospitalization.Clinical characteristics of two groups of patients and impact factors for prognosis of patients with multi-bacteria infection was compared. Results 430 patients were positive in blood culture, 367 cases (85.3%) were infected by mono-bacteria and 63 cases (14.7%) were infected by multi-bacteria.Healthcare-associated infection (HAI) rate in multi-bacteria group was higher than that in mono-bacteria group (76.2% vs 56.9%, P=0.003);lower respiratory tract infection rate in patients in multi-bacteria group was higher than that in mono-bacteria group (44.4% vs 29.2%, P=0.018).Hospitalization time of patients in multi-bacteria group was higher than that in mono-bacteria group (24[16-39]vs 19[13-26]day, P=0.002).Death rate of patients in multi-bacteria group was higher than that in mono-bacteria group (12.7% vs 3.8%), and hospitalization time was prolonged, difference was both significant (both P < 0.05).Multivariate analysis showed that independent risk factors for death in patients with BSI were multi-bacteria infection (OR=3.24, 95%CI=1.20-8.75), gastrointestinal tumor (OR=3.28, 95%CI=1.21-8.84), invasive mechanical ventilation (OR=3.40, 95%CI=1.22-9.42), deep vein catheterization (OR=2.76, 95%CI=1.00-7.64), and urinaryt ract catheterization (OR=3.28, 95%CI=1.04-10.40).Compared with the mono-bacteria group, the interval between specimen submission for detection and patients'discharge in multi-bacteria group was significantly longer (20[15-36]vs 16[10-22]days, P < 0.001).The constituent of Staphylococcus aureus, Staphylococcus haemolyticus and Escherichia coli detected in patients in multi-bacteria group and mono-bacteria group was significantly different (all P < 0.05). Conclusion The risk for death in hospitalized patients with multi-bacteria BSI is significantly increased, digestive tract tumor, invasive mechanical ventilation, deep vein catheterization, and urinary catheterization are independent risk factors for death of patients with BSI, which should be paid attention in clinic.