摘要
目的 探讨艾滋病患者血流感染病原菌分布特点及患者死亡的危险因素,为提高临床诊治水平、降低病死率提供有效依据.方法 回顾性分析南宁市第四人民医院急诊科2022年1月—2022年12月收治的艾滋病合并血流感染患者的临床资料,分析病原菌分布情况.根据住院期间患者存活或死亡,分为生存组及死亡组,用Logistic回归分析筛选患者死亡的独立危险因素.结果 艾滋病合并血流感染200例患者中,检出致病菌232株:其中真菌144株(62.07％),以马尔尼菲蓝状菌(55.60％)为主;革兰阴性菌35株(15.09％),以肠沙门氏菌(3.88％)和大肠埃希菌(3.88％)为主;分枝杆菌16株(6.90％);革兰阳性菌37株(15.95％),以人葡萄球菌(3.45％)和表皮葡萄球菌(3.45％)为主.200例患者中,死亡49例(24.5％),生存151例(75.5％),2组性别、年龄、白细胞计数、C-反应蛋白、血清淀粉样蛋白、红细胞压积、CD4+T细胞计数差异均无统计学意义(P均>0.05);单因素分析显示,死亡组血小板计数、白蛋白水平、内生肌酐清除率低于生存组,而降钙素原水平、复数菌感染率、脓毒性休克发生率、急性生理与慢性健康Ⅱ评分、序贯器官衰竭评分高于生存组,差异均有统计学意义(P均<0.05).多因素Logistic回归分析显示,内生肌酐清除率下降(OR=1.035)、发生脓毒性休克(OR=10.443)、急性生理与慢性健康Ⅱ评分>25(OR=7.708)是患者死亡的独立危险因素.结论 艾滋病患者血流感染率高,病原菌以真菌为主,患者病死率高.内生肌酐清除率下降、发生脓毒性休克、急性生理与慢性健康Ⅱ评分>25是患者死亡的独立危险因素.
Abstract
Objective To evaluate the distribution characteristics of pathogens that cause bloodstream infection in AIDS patients and to identify the risk factors that contribute to patient mortality, so as to establish a solid foundation for enhancing clinical diagnosis and treatment methods, ultimately leading to a reduction in the mortality rate. Methods The clinical data of AIDS patients with BSI admitted to the emergency department of our hospital during 2022 were analyzed retrospectively, focusing on the distribution of pathogenic bacteria. According to patients' outcome during hospitalization, they were divided into 2 groups: those who survived ( the survival group ) and those who did not ( the death group ). Logistic regression analysis was used to identify independent risk factors associated with mortality. Results Two hundred AIDS patients diagnosed with BSI were admitted to the emergency department in 2022, from which 232 strains of pathogenic bacteria were detected. The pathogens comprised 144 strains of fungi ( 62.07％ ), mainly Talaromyces marneffei ( 55.60％ ); 35 strains of Gram-negative bacteria ( 15.09％ ), with Salmonella enteritidis ( 3.88％ ) and Escherichia coli ( 3.88％ ) being the most common; 16 strains of Mycobacterium ( 6.90％ ); and 37 strains of Gram-positive bacteria (15.95％), with the majority being Staphylococcus hominis ( 3.45％ ) and Staphylococcus epidermidis ( 3.45％ ). Among the 200 patients, 49 ( 24.5％ ) died and 151 ( 75.5％ ) survived. There was no difference in gender, age, white blood cell count, C-reactive protein, serum amyloid protein, hematocrit and CD4+ T cells between the 2 groups ( P>0.05 ). Univariate analysis showed that the platelet count, albumin, and endogenous creatinine clearance rate in the death group were lower than those in the survival group, while procalcitonin, multiple bacterial infections, septic shock, acute physiological and chronic health Ⅱ scores, and sequential organ failure scores were higher than those in the survival group ( P<0.05 ), which were risk factors for patient mortality, all of which were statistically significant risk factors for mortality. Multivariate logistic regression analysis showed that decreased endogenous creatinine clearance rate ( OR=1.035 ), septic shock ( OR=10.443 ), and acute physiological and chronic health Ⅱ score > 25 ( OR=7.708 ) were independent risk factors for patient mortality. Conclusion The incidence of BSI in AIDS patients is high. This study identified fungi as the predominant pathogens responsible for BSI, which are associated with a significant mortality rate. Independent risk factors contributing to patient mortality include reduced creatinine clearance rate (Ccr), septic shock, and elevated APACHE Ⅱ scores.
基金项目
广西壮族自治区中医药局科研项目(G22C2020453)
NETL
NSTL
万方数据