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目的分析金黄色葡萄球菌血流感染(SA-BSI)临床治疗预后的相关因素。方法回顾性分析浙江大学医学院附属第一医院191例确诊为SA-BSI患者临床资料,以30d为节点,分为临床治疗成功组和临床治疗失败组。分析两组患者临床特征、APACHE II评分(Acute Physiology and Chronic Health Evaluation Scoaring)、感染来源危险分层、感染性休克发生率、早期治疗反应、是否耐甲氧西林、既往血培养阳性和万古霉素药敏等情况。结果 191例患者中治疗失败组与成功组相比有更高的APACHE II评分,感染来源危险分层高、感染性休克发生率高、缺乏3d早期治疗反应,耐甲氧西林金黄色葡萄球菌感染比例高;在多元回归分析中,早期治疗反应的缺乏与感染性休克发生、既往血培养阳性、多重感染源为30d治疗失败的独立预测因子。结论早期治疗反应是预测治疗失败最有力的因子。
Objective To analyze the related factors of prognosis of Staphylococcus aureus bloodstream infection (SA-BSI). Methods The clinical data of 191 patients diagnosed as SA-BSI in the First Affiliated Hospital of Zhejiang University Medical College were retrospectively analyzed. After 30 days, the patients were divided into two groups: clinical success group and clinical failure group. The clinical characteristics, APACHE II score (Acute Physiology and Chronic Health Evaluation Scoaring), risk stratification of origin of infection, incidence of septic shock, early response to treatment, methicillin-resistant, previous blood culture positive, and vancomycin Drug sensitivity and so on. Results Among the 191 patients, the treatment failure group had a higher APACHE II score than the successful group, with a high risk of stratified infection, high incidence of septic shock, lack of early response to 3d, and methicillin-resistant Staphylococcus aureus infection In multiple regression analysis, the lack of early response to treatment and septic shock, previous positive blood cultures, and multiple sources of infection were independent predictors of 30-day failure. Conclusion Early treatment response is the most powerful factor in predicting the failure of treatment.