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目的了解所在医院成人血流感染后影响预后的相关因素。方法收集所在医院2002年1月至2003年12月检验科记录的血培养阳性病例131例,查阅其中91例成人患者的相关临床资料,从而了解本院血流感染病原菌种类,分析影响预后的相关因素。结果 91例中革兰阴性菌53例(58.2%),主要为大肠埃希菌、沙门菌属细菌和肺炎克雷白杆菌;革兰阳性菌28例(30.8%),主要为金黄色葡萄球菌和凝固酶阴性葡萄球菌;真菌8例(8.8%),多重病原菌2例(2.2%)。本组脓毒血症患者在院病死率30.8%,铜绿假单胞菌、金黄色葡萄球菌、嗜麦芽窄食单胞菌以及大肠埃希菌产超广谱β内酰胺酶菌株感染者死亡率高达50%以上。在院病死率与病情严重程度(OR=1.15)、初始抗生素经验性治疗不合适(OR=6.77)有关。结论本研究所在医院成人血流感染病原菌以革兰阴性菌为主,病情严重以及初始抗生素经验性治疗不合适使血流感染病死率增加。
Objective To understand the related factors that influence the prognosis of adult bloodstream infection in the hospital where they are located. Methods Totally 131 blood culture positive cases were recorded in the laboratory from January 2002 to December 2003 in our hospital. The clinical data of 91 adult patients were reviewed to understand the types of pathogenic bacteria in bloodstream infection in our hospital and the correlation between prognosis and prognosis factor. Results Of the 91 cases, 53 (58.2%) were Gram-negative bacteria, mainly Escherichia coli, Salmonella and Klebsiella pneumoniae; Gram-positive bacteria were 28 (30.8%), mainly Staphylococcus aureus And coagulase-negative Staphylococcus; 8 fungi (8.8%), multiple pathogens in 2 cases (2.2%). In this group of sepsis patients in-hospital mortality rate of 30.8%, Pseudomonas aeruginosa, Staphylococcus aureus, Stenotrophomonas maltophilia, and Escherichia coli producing extended-spectrum β-lactamase strains infected with the mortality rate Up to 50% or more. In-hospital mortality was associated with the severity of illness (OR = 1.15) and inappropriate empirical antibiotic initial treatment (OR = 6.77). CONCLUSIONS: Gram-negative bacteria are the main pathogens causing bloodstream infections in hospital. The serious illness and improper initial antibiotic treatment led to increased bloodstream infection mortality.