2017—2021年某医院老年社区获得性血流感染患者临床特征及预后影响因素

Clinical characteristics and prognostic factors of elderly patients with CA-BSI in a hospital from 2017 to 2021

摘要:

目的 探讨老年社区获得性血流感染（CA-BSI）患者的临床特征及其预后影响因素，为临床治疗和预防提供依据。 方法 收集2017—2021年长沙市某三级甲等医院确诊为老年CA-BSI患者的病历资料，根据在院30天的预后结局分为生存组和死亡组，比较两组患者临床资料的差异，并分析影响CA-BSI患者预后的因素。 结果 共纳入575例老年CA-BSI患者，其中生存组535例，死亡组40例。单因素分析结果显示，老年CA-BSI患者死亡与性别、年龄、血液透析史、使用糖皮质激素、留置导管、合并心脏病、血清蛋白、肌酐、序贯性器官衰竭评分（SOFA）有关（均P < 0.05）。多因素logistic回归分析结果显示，年龄大（OR=1.062，95%CI：1.016~1.109）、SOFA评分高（OR=1.161，95%CI：1.067~1.262）、使用糖皮质激素（OR=6.006，95%CI：2.441~14.774）是老年CA-BSI患者死亡的独立危险因素，血清蛋白正常（OR=0.942，95%CI：0.891~0.995）是其保护因素。 结论 老年CA-BSI患者死亡风险高，需要提高患者免疫力，合理使用抗菌药物与糖皮质激素，以降低患者死亡的风险。

Abstract:

Objective To explore the clinical characteristics and prognostic factors of elderly patients with community-acquired bloodstream infection (CA-BSI), and provide basis for clinical treatment and prevention. Methods Medical records of elderly patients diagnosed with CA-BSI in a tertiary first-class hospital of Changsha from 2017 to 2021 were collected. Patients were divided into a survival group and a death group according to the prognosis after 30 days hospitalization. The differences in clinical data between two groups of patients were compared, and influencing factors for the prognosis in CA-BSI patients were analyzed. Results A total of 575 elderly CA-BSI patients were included in the analysis, with 535 cases in the survival group and 40 cases in the death group. Univariate ana-lysis results suggested that death of elderly CA-BSI patients was related to gender, age, history of hemodialysis, glucocorticoid usage, indwelling catheter, concomitant heart disease, albumin, creatinine, and sequential organ fai- lure assessment (SOFA) score (all P < 0.05). Multivariate logistic regression analysis results suggested that old age (OR=1.062, 95%CI: 1.016-1.109), high SOFA score (OR=1.161, 95%CI: 1.067-1.262), glucocorticoid usage (OR=6.006, 95%CI: 2.441-14.774) were independent risk factors for the death of elderly CA-BSI patients, while normal albumin (OR=0.942, 95%CI: 0.891-0.995) was a protective factor. Conclusion Elderly CA-BSI patients have high risks of death. It is necessary to improve the immunity of patients as well as use antimicrobial agents and glucocorticoids rationally, so as to reduce the risk of death in patients.