厌氧菌感染耐药性及菌血症死亡危险因素分析

Drug resistance of anaerobic infections and analysis of risk factors for mortality of anaerobic bacteremia

摘要:

目的：分析厌氧菌感染耐药性及菌血症死亡的危险因素。方法：收集本院2012年1月至2017年7月厌氧菌感染患者239例，按照是否为菌血症分为2组，其中菌血症组105例，非菌血症组134例。收集性别、年龄、感染类型、基础疾病、经验性抗生素治疗等临床资料，用卡方检验及多因素logistic回归分析厌氧菌菌血症死亡的危险因素。采用琼脂稀释法测定最低抑菌浓度（minimal inhibitory concentration，MIC）值，PCR方法扩增厌氧菌耐药基因（cepA，ermF，cifA，nim）。结果：239例为厌氧菌感染患者，105例为菌血症，134例为非菌血症。亚胺培南、哌拉西林-他唑巴坦、甲硝唑的敏感率均大于90.00%，其中2株亚胺培南耐药菌株均检测到cifA基因。105例菌血症患者中死亡21例，占20%。多因素logistic回归分析显示年龄（OR=1.080，95%CI=1.033～1.129，P=0.001）和血液恶性肿瘤（OR=42.899，95%CI=3.206～574.038，P=0.005）是死亡的独立危险因素。结论：亚胺培南、哌拉西林-他唑巴坦、甲硝唑对厌氧菌有较好的体外活性。厌氧菌感染死亡率高，高龄、血液恶性肿瘤提示预后差，应早期识别积极治疗。

Abstract:

Objective：To analyze drug resistance of anaerobic infections and risk factors for mortality of anaerobic bacteremia. Methods：In this hospital，239 patients with anaerobic infection were collected from January 2012 to July 2017，and were divided into two groups according to whether they were bacteremia，including 105 cases of bacteremia，and 134 cases of non-bacteremia. Sex，age，type of infection，underlying diseases，empirical antibiotic treatment and other clinical datas were collected. Risk factors for mortality of anaerobic bacteremia were analyzed by Chi-square test and multivariate logistic regression analysis. The minimal inhibitory concen－trations（MICs） were determined by agar dilution method. Antibiotic resistance genes（cepA，ermF，cifA，nim） were amplified by PCR. Results：A total of 239 patients with anaerobic infections were enrolled including 105 cases of bacteremia and 134 cases of non-bac－teremia. The sensitive rates to imipenem，piperacillin-tazobactam and metronidazole were more than 90.00%. Among 105 patients with bacteremia，21 died，accounting for 20%. Multivariate logistic regression analysis showed that age（OR=1.080，95%CI=1.033 to 1.129，P=0.001） and hematological malignancy（OR=42.899，95%CI=3.206 to 574.038，P=0.005） were independent risk factors for mortality. Conclusion：Imipenem，piperacillin-tazobactam and metronidazole have good in vitro activity against anaerobes. The mortal－ity of anaerobic infections is high. Age and hematological malignancies suggest poor prognosis. Therefore，early identification and active treatment are necessory.