【摘要】 目的 探讨多重耐药(MDR)革兰阴性杆菌血行感染与患者住院结局的相关性。方法 回顾分析2011-01-2012-12共254例革兰阴性杆菌血行感染的患者,其中89例为MDR革兰阴性杆菌感染。通过对比感染MDR革兰阴性杆菌和感染非MDR革兰阴性杆菌患者的住院时间、住院费用、ICU住院时间等住院结局相关事件,分析MDR革兰阴性杆菌血行感染与患者住院结局的相关性。结果 (1)感染MDR革兰阴性杆菌患者约占所有患者的35.0%;(2)在感染MDR革兰阴性杆菌的患者中,入院前使用抗生素治疗、合并腹部手术患者比例较高(均P<0.01),不恰当使用初始经验性抗生素比例较高(P<0.01),入住ICU的比例更高(P<0.05);(3)感染MDR革兰阴性杆菌的患者具有较高的30d病死率和较长的ICU住院时间,且抗生素治疗费用明显高于感染非MDR患者(均P<0.05);(4)多因素回归分析显示,感染MDR革兰阴性杆菌是患者院内死亡(OR=1.88,95%CI=1.43~8.33,P=0.022)、较高抗生素治疗费用的独立因素(OR=1.54,95%CI=1.11~4.55,P=0.034)。结论 院内感染MDR革兰阴性杆菌使住院患者的病死率升高,增加了患者的住院费用,对患者的住院结局具有不良影响。更多还原

【Abstract】 Objective To investigate the impact of bloodstream infections caused by multi-drug resistant gram-negative(GN) bacilli on the outcome of patients.Methods The clinical data of 254 patients infected by gram-negative bacilli admitted from January 2011 to December 2012 were analyzed retrospectively,including 89 patients infected with multi-drug resistant(MDR) gram-negative bacilli.The outcome events of patients infected with MDR GN bacilli and those with non-MDR GN bacilli were compared by t-test and multivariate regression analysis.Results The rates of previous antibiotic use and abdominal surgery,irrational antibiotic use and admission to ICU in patients with MDR bacilli infection were higher than those in patients with non-MDR bacilli infection(P<0.01 or 0.05).Patients infected with MDR bacteria had higher 30-d mortality rate,longer ICU stay,and higher cost of antibiotics treatment compared to those infected with non-MDR bacilli(all P<0.05).Multivariate regression analysis indicated that infection caused by MDR bacilli was an independent risk factor for hospital mortality(OR=1.88,95%Cl=1.43~8.33,P=0.022) and high antibiotics treatment costs(OR=1.54,95%CI=1.11-4.55,P=0.034).Conclusion Patients infected with multi-drug resistant gram-negative bacilli are associated with higher negative outcome compared to those infected with non MDR bacilli.更多还原