中国华东地区某三级医院2018—2021年链球菌血流感染患者临床特征及预后分析

Clinical characteristics and prognosis of patients with streptococcal bloodstream infection in a tertiary hospital in East China, 2018-2021

摘要:

目的 探讨链球菌血流感染的临床特征、危险因素、治疗及预后。 方法 选取2018年1月—2021年12月华东地区某三级教学医院收治的链球菌血培养阳性患者为研究对象, 收集其临床病历资料, 回顾性分析医院感染情况、预后的危险因素等。 结果 共纳入151例链球菌血流感染患者, 平均年龄为(55.5±17.9)岁, ＞60岁的患者占45.70%, 男性患者占61.59%, 89.40%患者有基础疾病, 其中实体肿瘤、心脏瓣膜病、肝胆疾病、高血压较为多见。链球菌血流感染的常见危险因素为手术、免疫抑制状态、皮肤黏膜完整性破坏等(均P＜0.05)。医院获得性感染患者占25.17%(38例), 常见基础疾病包括肝胆疾病、实体肿瘤、血液病、高血压等。医院获得性感染患者住院时间较社区感染更长, 急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ评分)高于社区感染患者, 差异均有统计学意义(均P＜0.05)。检出的151株链球菌中, α-溶血性链球菌(112株, 肺炎链球菌除外)对青霉素、左氧氟沙星、头孢曲松的敏感率分别为71.43%、80.38%、91.07%;β-溶血性链球菌(29株)对青霉素100%敏感; 肺炎链球菌对青霉素敏感率为50.00%。151例患者的30天全因病死率为6.62%(10例), 归因病死率为2.65%(4例)。二元logistic回归分析结果表明, 休克(OR=13.690, 95%CI: 1.482~126.470)、Pitt菌血症评分≥4分(OR=10.461, 95%CI: 1.042~105.005)是链球菌血流感染患者死亡的独立危险因素。 结论 链球菌血流感染以社区感染为主, 医院获得性链球菌血流感染危险因素较多, 休克、Pitt菌血症评分≥4分是链球菌血流感染患者死亡的独立危险因素。

Abstract:

Objective To investigate the clinical characteristics, risk factors, treatment and prognosis of streptococcal bloodstream infection (BSI). Methods Patients with positive Streptococcus blood culture in a tertiary teaching hospital in East China from January 2018 to December 2021 were selected as the research subjects, their clinical medical data were collected, healthcare-associated infection (HAI) and risk factors for prognosis were retrospectively analyzed. Results A total of 151 patients with streptococcal BSI were included in the analysis, with an average age of (55.5±17.9) years old, 45.70% were >60 years old, male patients accounted for 61.59%, and 89.40% of patients had underlying diseases such as solid tumors, heart valve disease, hepatobiliary diseases, and hypertension. The common risk factors for streptococcal BSI included surgery, immunosuppression, and disruption of skin or mucosal integrity(all P < 0.05). HAI accounted for 25.17% (n=38); common underlying diseases included hepatobiliary diseases, solid tumors, hematologic disorders, and hypertension. Patients with HAI had longer hospital stays and higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ scores) compared with patients with community-associated infection (CAI) (all P < 0.05). Among the 151 detected bacterial strains, the susceptibility rates of α-hemolytic Streptococcus (n=112, except Streptococcus pneumoniae) to penicillin, levofloxacin, and ceftriaxone were 71.43%, 80.38%, and 91.07%, respectively. β-hemolytic Streptococcus (n=29) were 100% susceptible to penicillin; Streptococcus pneumoniae had a susceptibility rate of 50.00% to penicillin. The 30-day allcause mortality of 151 patients was 6.62% (n=10), and the attributable mortality was 2.65% (n=4). Binary logistic regression analysis showed that shock (OR=13.690, 95%CI: 1.482-126.470) and Pitt bacteremia score ≥4 (OR=10.461, 95%CI: 1.042-105.005) were independent risk factors for mortality in patients with streptococcal BSI. Conclusion Streptococcal BSI is mainly CAI, and there are multiple risk factors for hospital-associated streptococcal BSI. Shock and Pitt bacteremia scores ≥4 are independent risk factors for death in patients with streptococcal BSI.