摘要
目的探讨铜绿假单胞菌血流感染的临床特点及细菌耐药性。方法回顾性分析北京大学第三医院2006年1月—2009年12月铜绿假单胞菌血流感染患者的临床及微生物学资料。结果 27例患者纳入分析。患者基础疾病评分(Charlson评分)为4.48±2.10;发生血流感染时均有发热、外周血白细胞减少或升高;9例患者发生感染中毒性休克,9例患者住院死亡。患者血流感染来源于下呼吸道感染最多,其次为中心静脉内导管相关感染。发生多重耐药(MDR)菌株感染6例。与非MDR组相比较,MDR组患者入院时的急性生理与慢性健康评估(APACHE)Ⅱ评分和感染相关器官衰竭评分(SOFA评分)显著升高,入住ICU时间显著延长,入院至血培养阳性前接受2类或2类以上抗菌药物治疗比率显著升高,血培养阳性后的适当经验性抗菌药物治疗率显著降低;两组Charlson评分、临床表现、抽取血培养时的APACHEⅡ评分与SOFA评分、住院病死率等差异无统计学意义。结论铜绿假单胞菌血流感染患者病情较重,病死率较高,该菌MDR菌株感染患者入院时病情多重于非MDR感染者,两者临床表现相似,应积极行病原学检查,尽早选用敏感抗菌药物治疗以降低病死率。
Objective To analyze the clinical characteristics and antimicrohial resistance of blood stream infections caused by P. aeruginosa. Methods The clinical data were retrospectively reviewed for the patients with P. aeruginosa bloodstream infection who were treated in Peking University Third Hospital from January 2006 to December 2009. Results A total of 27 patients were found with P. aeruginosa bloodstream infection. The Charlson scores of the patients were 4. 48 ±2.10. All patients had fever and increased or decreased white blood cell counts when their bloodstream infection was identified. Six patients were infected by multidrugresistant （MDR） strains. Compared with the patients with nonMDR P. aeruginosa infection, the patients infected by MDR strains had significantly higher APACHE 11 scores and Sequential Organ Failure Assessment （SOFA） scores at ad mission, longer stay in Intensive Care Unit （RICU and SICU）, higher prevalence of multiple （two or more） antibiotics use be fore positive blood culture after admission, and lower proprotion of patients with appropriate antibiotic therapy after blood cul ture. The Charlson scores, clinical manifestation, APACHEⅡ scores and SOFA scores at the time of bloodstream infection, and inhospital mortality were similar between the two groups of patients. Conclusions The patients with P. aeruginosa blood stream infection showed severe clinical status and high mortality rate. The MDR strainsinfected patients had more severe con ditions than those infected by nonMDR strains, but their clinical manifestations were similar. Patients with bloodstream infec tion should subject to microbiological testing and be treated with appropriate active agents as soon as possible to reduce fatality rate.
出处
《中国感染与化疗杂志》
CAS
北大核心
2013年第2期81-85,共5页
Chinese Journal of Infection and Chemotherapy
关键词
铜绿假单胞菌
血流感染
多重耐药
临床表现
P. aeruginosa bloodstream infection
multidrug-resistance clinical manifestation
