摘要
目的探讨血流感染合并肺部感染患者的临床特征、预后及其影响因素。方法纳入164例血流感染合并肺部感染患者。回顾性分析其血流感染类型、血流感染致病菌分布情况、肺部CT表现、基础疾病及其他易感因素、预后。分析影响血流感染合并肺部感染患者预后的影响因素。结果(1)血培养分离的病原体中,革兰阴性菌(46.3%)与革兰阳性菌(42.1%)所占比例相似;最常见的致病菌为凝固酶阴性葡萄球菌、大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、念珠菌属。(2)45.1%患者为医院获得性血流感染,54.9%患者为社区获得性血流感染。(3)86.0%患者存在基础疾病,主要有血液系统疾病、中枢神经系统疾病、2型糖尿病;61.6%患者存在其他易感因素。(4)革兰阳性菌所致血流感染的患者肺部影像学主要表现为多发团块状、结节状影,边界清楚,伴空洞形成;革兰阴性菌所致血流感染的患者主要表现为多发斑片状、条索状阴影,部分空洞形成,多伴有胸腔积液;真菌所致血流感染的患者则以结节状、斑片状和磨玻璃样改变为主,可伴有坏死空洞形成。(5)经治疗后好转127例(77.4%),预后不良37例(22.6%)。年龄≥60岁、有创机械通气、恶性肿瘤均为患者不良预后的危险因素(均P<0.05)。结论血流感染合并肺部感染的患者血培养出革兰阳性菌比例有上升趋势,不同致病菌的肺部影像学表现各有特点,预后不良的患者比例较高,而患者预后与基础疾病合并情况、侵入性操作、年龄等易感因素有关。
Objective To investigate the clinical features,prognosis and its influencing factors in bloodstream infection patients complicated with pulmonary infection.Methods A total of 164 bloodstream infection patients complicated with pulmonary infection were included.The related data were retrospectively analyzed,including type of bloodstream infection,distribution of pathogens for bloodstream infection,chest CT findings,basic diseases and other predisposing factors,prognosis.And the factors influencing the prognosis were analyzed in patients with bloodstream infection complicated with pulmonary infection.Results(1)Among the pathogens isolated from blood culture,Gram-negative bacteria was similar to Gram-positive bacteria in constituent ratio(46.3%vs.42.1%);the dominant pathogens included coagulase-negative Staphylococcus,Escherichia coli,Klebsiella pneumonia,Staphylococcus aureus and Candida.(2)Hospital-acquired and community-acquired bloodstream infection accounted for 45.1%and 54.9%respectively.(3)About 86.0%patients had basic diseases mainly involving hematological diseases,central nerve system disease and type 2 diabetes mellitus,and 61.6%patients had other predisposing factors.(4)Lung imaging findings were mainly presented as multiple crumby and nodular shade with distinct margin and cavities formation in patients with bloodstream infection caused by Gram-positive bacteria,multiple plaque-like or streak shade partially with cavities formation and commonly accompanied with pleural effusion in patients with bloodstream infection caused by Gram-negative bacteria,and nodular/plaque-like/ground-glass opacity changes probably with necrotic cavities formation in patients with bloodstream infection caused by fungi.(5)After treatment,improvement was found in 127(77.4%)cases and poor prognosis in 37(22.6%)cases.Age≥60 years,invasive mechanical ventilation,and malignant tumors were all the risk factors for poor prognosis in the patients(all P<0.05).Conclusion In patients with bloodstream infection complicated with pulmonary infection,the proportion of Gram-positive bacteria isolated from blood culture yields a tendency to rise,pulmonary imaging manifestations of cases caused by different pathogens have their own characteristics,the proportion of patients with poor prognosis is relatively high,and patients′prognosis is related to predisposing factors including underlying disease status,invasive procedure and age.
作者
朱彩凤
杨彩红
李梅华
韦燕琳
唐晓娟
马南
罗州玲
邱居烽
黄梅
梁权
ZHU Cai-feng;YANG Cai-hong;LI Mei-hua;WEI Yan-lin;TANG Xiao-juan;MA Nan;LUO Zhou-lin;QIU Ju-feng;HUANG Mei;LIANG Quan(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)
出处
《广西医学》
CAS
2020年第13期1625-1629,共5页
Guangxi Medical Journal
基金
国家自然科学基金(81360012)
广西自然科学基金(2016GXNSFAA380269)。
关键词
血流感染
肺部感染
致病菌
影像学表现
预后
影响因素
Bloodstream infection
Pulmonary infection
Pathogen
Imaging findings
Prognosis
Influencing factor
