CAJ | 학술논문

目的探讨与大肠杆菌菌血症患者细菌快速生长相关的临床及实验室指标以及影响患者预后的危险因素.方法回顾分析2007年1月至2009年12月在北京大学第三医院住院治疗的大肠杆菌菌血症患者的临床数据以及细菌学资料,应用血液培养阳性报警时间(TTP)作为反映细菌生长速度的指标,通过单因素分析研究细菌生长速度和临床指标之间的关系,并对影响患者住院病死率的危险因素进行Logistic多元回归分析.结果共有112例大肠杆菌菌血症患者纳入本研究,其中25例在住院期间死亡,病死率为22.3%.细菌快速生长(TTP≤7 h)组(20例)中性粒细胞减少发生率(40.0%比15.2%)、原发性菌血症发生率(40.0%比18.5%)以及住院病死率(45.0%比17.4%)均明显高于细菌缓慢生长(TTP＞7 h)组(92例,均P<0.05).死亡组(25例)TTP≤7 h(36.0%比12.6%)、活动性恶性肿瘤(44.0%比24.1%)、中性粒细胞减少(36.0%比14.9%)、产超广谱β内酰胺酶(ESBL)菌株(48.0%比24.1%)的发生率均明显高于存活组(87例,均P<0.05).应用Logistic多元回归分析显示,TTP≤7 h[相对危险度(OR)3.412,95%可信区间(95%CI)1.181～9.856,P=0.023]、产ESBL菌株(OR 2.545,95%CI 0.977～6.625,P=0.056)为影响患者住院病死率的独立危险因素.结论大肠杆菌菌血症患者体外血液培养细菌生长速度与中性粒细胞减少以及原发性菌血症发生率相关,TTP≤7 h、产ESBL菌株是影响患者住院病死率的两个独立危险因素.
목적 탐토여대장간균균혈증환자세균쾌속생장상관적림상급실험실지표이급영향환자예후적위험인소.방법 회고분석2007년1월지2009년12월재북경대학제삼의원주원치료적대장간균균혈증환자적림상수거이급세균학자료,응용혈액배양양성보경시간(TTP)작위반영세균생장속도적지표,통과단인소분석연구세균생장속도화림상지표지간적관계,병대영향환자주원병사솔적위험인소진행Logistic다원회귀분석.결과 공유112례대장간균균혈증환자납입본연구,기중25례재주원기간사망,병사솔위22.3%.세균쾌속생장(TTP≤7 h)조(20례)중성립세포감소발생솔(40.0%비15.2%)、원발성균혈증발생솔(40.0%비18.5%)이급주원병사솔(45.0%비17.4%)균명현고우세균완만생장(TTP＞7 h)조(92례,균P<0.05).사망조(25례)TTP≤7 h(36.0%비12.6%)、활동성악성종류(44.0%비24.1%)、중성립세포감소(36.0%비14.9%)、산초엄보β내선알매(ESBL)균주(48.0%비24.1%)적발생솔균명현고우존활조(87례,균P<0.05).응용Logistic다원회귀분석현시,TTP≤7 h[상대위험도(OR)3.412,95%가신구간(95%CI)1.181～9.856,P=0.023]、산ESBL균주(OR 2.545,95%CI 0.977～6.625,P=0.056)위영향환자주원병사솔적독립위험인소.결론 대장간균균혈증환자체외혈액배양세균생장속도여중성립세포감소이급원발성균혈증발생솔상관,TTP≤7 h、산ESBL균주시영향환자주원병사솔적량개독립위험인소.
Objective To identify the clinical and laboratory parameters correlating with speed of bacterial growth in culture and independent risk factors of in-hospital mortality in patients with Escherichia coli bacteremia. Methods This retrospective study was conducted at Beijing University Third Hospital. The medical records and microbiological database of the patients diagnosed as Escherichia coli bacteremia between January 2007 and December 2009 were collected. The parameter of time to positivity (TTP) was used to be a surrogate marker of bacterial growth. Univariate analysis was used to identify relationship between clinical parameters and the speed of bacterial growth. Logistic multivariate analysis was used to identify risk factors of in-hospital mortality. Results The medical records of 112 patients during the study period were collected, 25 patients died during hospital stay, the overall in-hospital mortality rate was 22.3%. Univariate analysis indicated the rapid-growth (TTP≤7 hours) group (n=20) had higher incidence of neutropenia (40.0% vs. 15.2%), higher incidence of primary bacteremia (40.0% vs. 18.5%) and higher in-hospital mortality rate (45.0% vs. 17.4%) than those with slow bacterial growth (TTP＞7 hours) group (n=92, all P<0.05). The death group (n=25) was found to have a higher incidence of TTP≤7 hours (36.0% vs. 12.6%), higher incidence of active malignancies (44.0% vs. 24.1%), higher incidence of neutropenia (36.0% vs. 14.9%), higher rate of isolation of extended spectrum β lactamases (ESBL)-producing strains (48.0% vs. 24.1%) than the survival group (n=87, all P<0.05). Logistic multivariate analysis suggested the significant predictors of in-hospital mortality included TTP≤7 hours [odds ratio (OR)=3.412, 95% confidence interval (95%CI)=1.181 9.856, P=0.023], ESBL-producing strains (OR=2.545, 95%CI=0.977 6.625, P=0.056). Conclusion In vitro Escherichia coli growth speed in the blood culture correlates with the incidence of neutropenia and primary bacteremia, and TTP≤7 hours and ESBL-producing strains may be the strong, independent risk factors of a worse prognosis in patients with Escherichia coli bacteremia.