【作者】 徐慧；

【导师】 周建英；

【作者基本信息】 浙江大学 ， 内科学， 2015， 硕士

【摘要】 目的：本研究旨在探讨肠球菌血流感染的临床特征、危险因素、预后及细菌耐药情况,为临床上诊疗肠球菌血流感染提供参考和帮助。方法：对浙江大学医学院附属第一医院(2013年1月至2014年10月)117例确诊肠球菌血流感染的住院患者的临床资料进行回顾性分析。根据肠球菌感染种类分为粪肠球菌血流感染组(37例)和屎肠球菌血流感染组(72例)。研究患者的人口学特点、基础疾病、临床表现、实验室检查、预后情况及细菌药敏结果。结果：117例确诊肠球菌血流感染患者,年龄范围14-89岁,平均(60.54-15.7)岁；其中男性79例。分别为屎肠球菌感染72例,类肠球菌感染37例,鸟肠球菌感染5例,鹑鸡肠球菌感染3例。男性、肝胆疾病、心血管疾病、侵入性操作、腹部手术、2周内抗菌药物使用是肠球菌血流感染可能高危因素。96例患者有不同程度发热表现。单因素分析提示屎肠球菌BSI组较粪肠球菌BSI组患者APACHEⅡ评分更高,住院天数更长,MODS、接受激素治疗及动静脉置管比例更高,均有统计学差异(P值<0.05)。屎肠球菌较粪肠球菌对青霉素G、氨苄西林、喹诺酮类的耐药率显著增高。117例患者送检血培养标本检出4株万古霉素耐药菌株,6株利奈唑胺耐药菌株,4株利奈唑胺中介菌株,未发现替加环素耐药菌株。10例利奈唑胺不敏感肠球菌感染患者中9例接受了敏感抗菌药物治疗,7例患者细菌清除,6例患者治疗好转出院,4例患者死亡于多脏器功能衰竭。肠球菌BSI患者30天内病死率为23.9%,多因素回归分析结果发现激素治疗、休克、未选用敏感药物治疗是30天内死亡的危险因素。未发现屎肠球菌血流感染与：死亡率增加的相关性。结论：肠球菌血流感染好发于免疫功能缺陷患者,总体死亡率较高,激素治疗、休克、末选用敏感药物是30天内死亡的危险因素。屎肠球菌感染形势严峻,具有高耐药性、患者基础疾病更严重等特点,临床治疗更棘手,预后更差。更多还原

【Abstract】 Objective:To observethe clinical features,risk factors, outcomes and drug resistance of 117 patients with enterococcal bloodstream infections (BSI),and provide help for clinical diagnosis and treatment of entercoccal BSI.Methods:A retrospective study was carried out to analyze the medical records of 117 patients which were confirmed diagnosis with enterococcal bloodstream infections in the First Affiliated Hospital of Zhejiang University School of Medicine from February 2013 to October 2014. According to enterococcus species, they were divided into two groups: E. f aecalis BSI group (37 cases) and E. f aecium BSI group (72 cases). This research analyzed patients’ demographic features,clinical fectures,laboratory examination, outcomes and drug resistance.Results:A total of 117 patients were selected, with 79 males, and the average age was 60.5±15.7 years old (ranged from 14 to 89 years). There were 72 cases of E.faecium,37 cases of E.faecalis,5 cases of E.avium and 3 cases of E.gallinarum. Male,liver disease,cardiovascular disease,invasive procedures,abdominal surgery, received antibiotic treatment in two weeks before a positive culture may were risk factors of entercoccal BSI.96 patients had different degrees of fever. According to univariate analysis,there were great differences between two groups in APACHE II score, hospital stay, MODS, received corticosteroid therapy and arteriovenous catheter. There were significant differences between two groups in drug resistance to penicillin G,ampicillin,quinolones(P<0.05). There were 4 cases of vancomycin-resistant strains,6 cases of linezolid-resistant strains,4 cases of linezolid-medium sensitive stains,none of tigecycline-resistant. Among 10 cases of linezolid-nonsusceptible entercoccal BSI,9 cases received active antimicrobial therapy,7 cases blood culture were negative (bacteria removal),6 cases were clincical improved,4 cases died of MODS. The 30-day mortality of entercoccal BSI was 23.9%. In multivariate analysis, received corticosteroid therap,shock,and not receiving active antimicrobial therapy. were independent predictive factors for 30-day mortality. No significant association were found between E.faecium BSI and the increased mortality.Conclusion:Entercoccal BSI in patients with immune deficiencies showed high mortality.Independent risk factors for the 30-day mortality were received corticosteroid therapy,shock,and not receiving active antimicrobial therapy.E.faecium is associated with higher antimicrobial resistance and infection rate.The patients due to E.faecium BSI are associated with more severe underlying diseases,who meet more difficulty in the clinical treatment.更多还原