CAJ | 학술논문

目的了解皮肌炎住院患者的感染情况,探讨皮肌炎患者发生感染的相关危险因素.方法回顾性分析2002年5月-2007年7月在复旦大学附属华山医院确诊为皮肌炎的307例住院患者的感染发生情况及对病原菌的耐药情况;选择皮肌炎患者感染发生的可疑危险因素,先通过X~2检验进行单因素分析,然后对差异有统计学意义的因素运用Logistic回归分析进行多因素分析.结果 307例皮肌炎患者中,发生感染108例,感染发生率为35.2%.17例死亡患者均合并呼吸道感染.常见的感染部位依次为呼吸道(76.9%)、尿路(13.9%)、口腔(13.0%)及皮肤软组织(7.4%).在感染病原体构成中,以革兰阴性菌为主.最常见的菌株为克雷伯菌属(13.5%)、不动杆菌属(6.2%)、金黄色葡萄球菌(10.4%)及白念珠菌(33.3%).细菌药敏试验结果显示,耐药菌株中产超广谱β内酰胺酶(ESBL)菌株7株(38.9%),耐甲氧西林葡萄球菌(MRSA)5株(42.1%).革兰阴性菌对头孢哌酮/舒巴坦及碳青霉烯类药物的敏感率较高.≥60岁(β=0.697)、肺间质病变(β=1.466)、吞咽困难(β=0.737)及大剂量激素治疗(累积激素用量≥1 g,β=0.700)为皮肌炎患者感染发生的独立危险因素(P值均<0.05).结论对存在上述感染相关危险因素的患者,应密切监测有无感染的发生.呼吸道为皮肌炎患者最常见的感染部位,预后较差;病原菌以革兰阴性菌多见,可选用头孢他啶、头孢哌酮/舒巴坦或碳青霉烯类药物作为经验性抗感染治疗.
목적 료해피기염주원환자적감염정황,탐토피기염환자발생감염적상관위험인소.방법 회고성분석2002년5월-2007년7월재복단대학부속화산의원학진위피기염적307례주원환자적감염발생정황급대병원균적내약정황;선택피기염환자감염발생적가의위험인소,선통과X~2검험진행단인소분석,연후대차이유통계학의의적인소운용Logistic회귀분석진행다인소분석.결과 307례피기염환자중,발생감염108례,감염발생솔위35.2%.17례사망환자균합병호흡도감염.상견적감염부위의차위호흡도(76.9%)、뇨로(13.9%)、구강(13.0%)급피부연조직(7.4%).재감염병원체구성중,이혁란음성균위주.최상견적균주위극뢰백균속(13.5%)、불동간균속(6.2%)、금황색포도구균(10.4%)급백념주균(33.3%).세균약민시험결과현시,내약균주중산초엄보β내선알매(ESBL)균주7주(38.9%),내갑양서림포도구균(MRSA)5주(42.1%).혁란음성균대두포고동/서파탄급탄청매희류약물적민감솔교고.≥60세(β=0.697)、폐간질병변(β=1.466)、탄인곤난(β=0.737)급대제량격소치료(루적격소용량≥1 g,β=0.700)위피기염환자감염발생적독립위험인소(P치균<0.05).결론 대존재상술감염상관위험인소적환자,응밀절감측유무감염적발생.호흡도위피기염환자최상견적감염부위,예후교차;병원균이혁란음성균다견,가선용두포타정、두포고동/서파탄혹탄청매희류약물작위경험성항감염치료.
Objective To investigate the infections in patients with dermatomyositis (DM), and to analyze the risk factors of infection in DM patients. Methods The infections and drug resistance in 307 DM patients, who had been treated in Huashan hospital between 2002 and 2007, were retrospectively reviewed. The infection sites, pathogens and the tolerance of pathogenic bacteria were investigated. The suspected risk factors of infections in DM patients were selected and then analyzed by chi-square test, and the factors of interest were subjected for Logistic regression analysis. Results Incidence of infection was 35.2% (108/307) in the 307 DM patients. Seventeen death cases were related to respiratory infections. The common infection sites were respiratory tract (76.9%), urinary tract (13.9%), oral cavity (13.0%), and skin (7.4%). Gram-negative were the most common pathogens of infections in DM patients. The common strains for infections in DM patients included Klebsiella spp. (13.5%), Acinetobacter (6.2%), Staphylococcus aureus (10.4%) and Candida a/bus (33. 3%). Antimicrobial susceptibility tests showed a high proportion of drug resistant bacteria, including 7(38.9%) ESBLs-producing strains and 5 (42.1%) strains were MRSA. The gram-negative ones were sensitive to cefoperazone-sulbactam and carbopenems. The infection-related risk analysis suggested that the independent risk factors of infections in DM patients included elder age (β = 0. 697), interstitial lung diseases (β = 1. 466), dysphagia (β = 0. 737) and high doses of corticosteroids treatment (β = 0. 700). Conclusion DM patients with infection-related risk factors should be watched closely for infections. Respiratory tracts are the most common infectious sites in DM patients, and the infection alwavs leads to unfavouable prognoses.The infections are mainly caused by gram-negative bacteria，so ceftazidime，cefoperazone-sulbactarn or carbopenems can be chosen before the result of antimicrobial susceptibility test is available．