摘要
目的探究耐碳青霉烯类铜绿假单胞菌血流感染(carbapenem-resistant Pseudomonas aeruginosa bloodstream infection,CRPA-BSI)患者的预后情况及其影响因素。方法该研究为单中心回顾性队列研究,选取2017年-2021年于四川大学华西医院发生铜绿假单胞菌血流感染患者的临床资料,比较CRPA-BSI患者与碳青霉烯敏感铜绿假单胞菌血流感染(carbapenem-sensitive Pseudomonas aeruginosa bloodstream infection,CSPA-BSI)患者的预后情况,采用Cox回归分析CRPA-BSI患者预后不良的影响因素。结果共纳入53例CRPA-BSI患者和175例CSPA-BSI患者,根据年龄校正的Charlson合并症指数(age-adjusted Charlson Comorbidity Index,aCCI)将患者进行1∶1匹配以控制混杂因素。在aCCI相近时,CRPA-BSI患者的预后不良发生率高于CSPA-BSI患者[41.5%vs.18.9%;相对危险度=2.20,95%置信区间(confidence interval,CI)(1.16,4.19),P=0.011],CRPA-BSI组住院时间中位数比CSPA-BSI组延长3 d但差异无统计学意义(29 vs.26 d,P=0.388)。单因素Cox回归分析结果显示最高体温≤39℃(P=0.014)、患有肝胆胰疾病(P=0.011)、中心静脉置管时间(P=0.025)、留置导尿管时间(P=0.037)、根据药敏结果调整用药时间(P=0.015)和Pitt菌血症评分(P=0.007)与CRPA-BSI患者预后不良有关;多因素Cox回归分析结果显示肝胆胰疾病[危险比(hazard ratio,HR)=3.434,95%CI(1.271,9.276),P=0.015]和Pitt菌血症评分[HR=1.264,95%CI(1.057,1.510),P=0.010]与CRPA-BSI患者的不良预后独立相关。结论与CSPA-BSI患者相比,CRPA-BSI患者的预后较差,肝胆胰疾病会显著增加CRPA-BSI患者不良预后的发生风险,Pitt菌血症评分是CRPA-BSI患者预后的预测因素。
Objective To explore the overall outcome and its factors of patients with carbapenem-resistant Pseudomonas aeruginosa bloodstream infection(CRPA-BSI).MethodsA single-center,retrospective cohort study was carried out.The demographic and clinical data of all emergency patients and inpatients in West China Hospital of Sichuan University from 2017 to 2021 were collected.Firstly,the prognosis of patients with CRPA-BSI was compared with those with carbapenem-sensitive Pseudomonas aeruginosa bloodstream infection(CSPA-BSI).Then Cox regression was used to analyze the factors affecting the prognosis of CRPA-BSI patients.Results A total of 53 patients with CRPA-BSI and 175 patients with CSPA-BSI were enrolled,and they were 1:1 matched according to the age-adjusted Charlson Comorbidity Index(aCCI)to control for confounding factors.When aCCI was similar,the incidence of poor prognosis in CRPA-BSI patients was significantly higher than that in CSPA-BSI patients[41.5%vs.18.9%;relative risk=2.20,95%confidence interval(CI)(1.16,4.19),P=0.011].The median length of hospital stay in the CRPA-BSI group was 3 d longer than that in the CSPA-BSI group but the difference was not statistically significant(29 vs.26 d,P=0.388).With regard to prognostic factors,univariate Cox regression analyses showed that the highest temperature≤39℃(P=0.014),hepatobiliary and pancreatic diseases(P=0.011),days of central venous catheterization(P=0.025),days of indwelling urinary catheters(P=0.037),adjustment of medication duration according to drug sensitivity results(P=0.015)and Pitt bacteremia score(P=0.007)were related to the poor prognosis of CRPA-BSI patients.Multiple Cox regression analysis showed that hepatobiliary and pancreatic disease[hazard ratio(HR)=3.434,95%CI(1.271,9.276),P=0.015]and Pitt bacteremia score[HR=1.264,95%CI(1.057,1.510),P=0.010]were independently associated with poor outcome in CRPA-BSI patients.Conclusions The prognosis of CRPA-BSI patients is worsen than that of CSPA-BSI patients.Hepatobiliary and pancreatic diseases signif
作者
李霖
黄文治
乔甫
LI Lin;HUANG Wenzhi;QIAO Fu(Department of Infection Control,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;West China School of Public Health/West China Fourth Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)
出处
《华西医学》
CAS
2023年第3期352-357,共6页
West China Medical Journal
基金
国家卫生健康委卫生发展研究中心研究课题(2020-53)。
关键词
耐碳青霉烯类铜绿假单胞菌
血流感染
预后
影响因素
Carbapenem-resistant Pseudomonas aeruginosa
bloodstream infection
prognosis
influencing factor
