本文選題：嗜麥芽窄食單胞菌 + 血流感染��； 參考：《浙江大學(xué)》2017年碩士論文

【摘要】：目的:探討嗜麥芽窄食單胞菌血流感染的臨床特點(diǎn)、治療方案和預(yù)后,為臨床嗜麥芽窄食單胞菌血流感染防治提供有力證據(jù)。方法:對(duì)浙江大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院2012年1月至2015年8月診斷為嗜麥芽窄食單胞菌血流感染的住院患者的臨床資料進(jìn)行回顧性分析,且進(jìn)行臨床特征相關(guān)性分析以及l(fā)ogistics回歸分析。結(jié)果:54例嗜麥芽窄食單胞菌血流感染患者平均年齡50.5歲,檢出前平均住院16天。17例(31%)合并有其他細(xì)菌感染,43例(80%)合并其他系統(tǒng)感染,其中合并肺部感染最常見(jiàn)(32例,占59.3%)。嗜麥芽窄食單胞菌血流感染多發(fā)生于惡性實(shí)體腫瘤、血液病患者(各占29.6%),最常見(jiàn)于肝膽外科(25.9%)等科室,37例患者存在中心靜脈置管(68.5%)。在血培養(yǎng)嗜麥芽窄食單胞菌陽(yáng)性前,54例患者中52例使用了抗菌藥物;在血培養(yǎng)陽(yáng)性后,54例患者均使用了抗菌藥物,其中有42例調(diào)整了抗菌藥物。治療藥物主要是β-內(nèi)酰胺酶抑制劑復(fù)合制劑29例(53.7%),喹諾酮類(lèi)11例。54例患者好轉(zhuǎn)32例(59%),死亡22例(41%);好轉(zhuǎn)組 APACHEII 評(píng)分(14.13±4.54)、死亡組 APACHEII 評(píng)分(27.59±8.17),兩組有統(tǒng)計(jì)學(xué)差異(P0.05)。合并其他部位感染、有中心靜脈置管、高APACHEII評(píng)分組死亡率更高(P0.05),而血培養(yǎng)陽(yáng)性后拔除中心靜脈管,使用敏感抗生素組死亡率更低(P0.05)。相關(guān)性分析顯示APACHEII評(píng)分、檢出前住院時(shí)間、CRP水平、有中心靜脈置管及合并器官感染與嗜麥芽窄食單胞菌血流感染預(yù)后呈現(xiàn)明顯負(fù)相關(guān)(P0.05),血培養(yǎng)陽(yáng)性后拔除中心靜脈置管、使用敏感抗生素與嗜麥芽窄食單胞菌血流感染患者預(yù)后的保護(hù)性因素(P0.05)。進(jìn)一步進(jìn)行多元二分類(lèi)logistics回歸分析發(fā)現(xiàn)中心靜脈置管與嗜麥芽窄食單胞菌血流感染預(yù)后呈負(fù)相關(guān)(OR值為174.461,P0.05),拔除中心靜脈置管與嗜麥芽窄食單胞菌血流感染預(yù)后呈正相關(guān)(OR值為0.018,P0.05)。結(jié)論:嗜麥芽窄食單胞菌血流感染多見(jiàn)于免疫力低下的危重患者,多發(fā)生在院內(nèi)外科手術(shù)操作的科室,多伴有中心靜脈置管,且容易合并其他部位感染。目前嗜麥芽窄食單胞菌血流感染預(yù)后一般,APACHEII評(píng)分高,嗜麥芽窄食單胞菌血培養(yǎng)檢出前住院時(shí)間長(zhǎng)、多合并其他部位感染以有炎癥表現(xiàn)的患者病死率更高,預(yù)后差。而血培養(yǎng)陽(yáng)性后拔除中心靜脈置管、及時(shí)使用敏感抗菌藥物可改善嗜麥芽窄食單胞菌血流感染患者的預(yù)后良好。尤其影響嗜麥芽窄食單胞菌血流感染預(yù)后的危險(xiǎn)因素為中心靜脈置管,保護(hù)因素為拔除中心靜脈置管。這提示臨床防治麥芽窄食單胞菌血流感染的一個(gè)重要措施應(yīng)減少中心靜脈置管的手術(shù)操作,以切斷嗜麥芽窄食單胞菌血流感染的途徑。
[Abstract]:Objective: to investigate the clinical features, treatment and prognosis of Stenotrophomonas maltophilia infection, and to provide evidence for the prevention and treatment of Stenotrophomonas maltophilia blood flow infection. Methods: the clinical data of hospitalized patients diagnosed as Stenotrophomonas maltophilia from January 2012 to August 2015 in the first affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. The correlation analysis of clinical features and logistics regression analysis were carried out. Results the average age of 54 patients with blood stream infection of T. maltophilia was 50.5 years old. The average hospital stay before detection was 16 days. 17 patients were admitted to hospital for 16 days. There were 43 patients with other bacterial infection and 80 patients with other systemic infection. Among them, 32 cases were complicated with pulmonary infection, accounting for 59.3%. Stenotrophomonas maltophilia blood flow infection mostly occurred in malignant solid tumors. In 37 patients with hematologic diseases (29.6m, 25.9%, respectively), central venous catheterization was found in 37 patients. Antibiotics were used in 52 of 54 patients who were positive for Stenotrophomonas maltophilia in blood culture, and in 54 patients after positive blood culture, 42 of them adjusted antibiotics. The main therapeutic drugs were 尾 -lactamase inhibitor compound preparation (29 cases, 53.7%), quinolones (11 cases, 54 cases), improvement (32 cases), death (22 cases), APACHEII score (14.13 鹵4.54), APACHEII score (27.59 鹵8.17) in the death group, there was statistical difference between the two groups (P 0.05). In the group of high APACHEII score, the mortality rate was higher than that in the group with high APACHEII score, but the central venous tube was removed after positive blood culture, and the mortality rate in the group of sensitive antibiotics was lower than that in the group of sensitive antibiotics. Correlation analysis showed that APACHEII score, hospitalization time before detection, central venous catheterization and complicated organ infection were negatively correlated with the prognosis of Stenomonas maltophilia blood stream infection (P 0.05), and central vein catheterization was removed after positive blood culture. Protective factors of prognosis in patients with Stenotrophomonas maltophilia and sensitive antibiotics. Further multivariate binary logistics regression analysis showed that there was a negative correlation between central venous catheterization and the prognosis of Stenotrophomonas maltophilia blood stream infection. The OR value was 174.461 (P 0.05), and the OR value was 0. 018% (P 0. 05) when the central venous catheter was pulled out and the prognosis of the blood stream infection of Stenomonas maltophilia was positively correlated. Conclusion: the infection of Stenotrophomonas maltophilia is more common in the critically ill patients with low immunity. It often occurs in the department of surgical operation in the hospital, and it is often accompanied by central venous catheterization, and it is easy to be complicated with infection in other parts. At present, the prognosis of Stenotrophomonas maltophilia blood stream infection is generally higher than that of APACHEII score, the hospitalization time is long before the blood culture of Stenotrophomonas maltophilia is detected, and the mortality of patients with inflammation is higher and the prognosis is poor. The positive blood culture can improve the prognosis of patients with blood stream infection by removing central venous catheter and using sensitive antibiotics in time. In particular, the risk factors affecting the prognosis of Stenotrophomonas maltophilia were central venous catheterization, and protective factors were extubation of central venous catheterization. It is suggested that an important measure to prevent and treat the infection of Stenotrophomonas maltophilia is to reduce the operation of central venous catheterization in order to cut off the route of blood stream infection of Stenomonas maltophilia.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R515
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本文編號(hào)：1957126