摘要
目的分析恶性血液病患者血流感染病原菌分布及药物敏感性,探讨死亡危险因素,为有效治疗血液病患者血流感染、降低病死率提供有效依据。方法回顾性分析西南医科大学附属医院血液科2015年1月-2017年12月111例患者血液细菌培养结果、药敏试验结果、临床资料及预后,采用SPSS 17.0软件进行统计学分析。结果 111例血流感染患者血液中共培养出细菌114株,革兰阴性菌占65.8%,革兰阳性菌占34.2%;发生血流感染28 d内病死率为21.6%;通过卡方检验单因素分析发现,病死率在不同中性粒细胞数(P=0.002)、D-二聚体(P=0.011)、白蛋白(P<0.001)水平中存在差异;通过Logistic回归分析发现D-二聚体升高(OR=1.36)、白蛋白降低(OR=0.83)是患者28 d内死亡的独立危险因素;D-二聚体区分死亡与存活患者的受试者工作特征曲线下面积(AUC)为0.872,临界诊断值为2.0 mg/L(灵敏度87.5%,特异度67.8%),白蛋白区分死亡与存活患者的AUC为0.761,临界诊断值为36.3 g/L(灵敏度83.3%,特异度51.7%)。结论血液病血流感染致病菌以革兰阴性菌为主;密切关注患者D-二聚体和白蛋白水平可较为准确地评估患者预后,为合理积极的治疗提供依据,从而降低血流感染患者病死率。
Objective To analyze the distribution and antimicrobial susceptibility of the pathogens causing bloodstream infections in patients with hematological disease,and to examine the risk factors of death,so as to provide evidence for effective treatment of bloodstream infections and reducing mortality.Methods The data of 111 patients treated in Department of Hematology from January 2015 to December 2017 were reviewed retrospectively,including results of blood culture,antimicrobial susceptibility test,clinical data and patient outcomes.The data were analyzed by using SPSS Statistics 17.0.Results A total of 114 bacterial strains were identified,including gram negative bacteria(65.8%)and gram positive bacteria(34.2%).The 28-day mortality of the patients with bloodstream infection was 21.6%.Chi-square test in univariate analysis found that the mortality of patients varied significantly with neutrophils count(P=0.002),D-dimer(P=0.011),and albumin(P<0.001).Logistic regression analysis indicated that high level D-dimer(OR=1.36),low level serum albumin(OR=0.83)were independent risk factors of 28-day mortality.The area under the receiver operating characteristic curves(AUC)of D-dimer was 0.872.The cutoff value for diagnosis was 2.0 mg/L(sensitivity 87.5%,specificity 67.8%).Albumin’s AUC was 0.761.The diagnostic cutoff value was 36.3 g/L(sensitivity 83.3%,specificity 51.7%).Conclusions Gram-negative bacteria are the main pathogens causing bloodstream infections.Clinicians should pay more attention to the role of serum D-dimer and albumin levels in assessing patient outcomes so that effective measures can be taken to reduce the mortality of patients with bloodstream infections.
作者
肖鸿文
张惠桃
熊皓
李晓明
XIAO Hongwen;ZHANG Huitao;XIONG Hao;LI Xiaoming(Department of Hematology,Affiliated Hospital of Southwest Medical University,Luzhou Sichuan 646000,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2018年第5期461-466,共6页
Chinese Journal of Infection and Chemotherapy
关键词
血液病
血流感染
病原菌
危险因素
hematological disease
bloodstream infection
pathogenic bacteria
risk factor
