Analysis Of Clinical Risk Factors Of Fatal Staphylococcus Aureus Bacteremia In Adult

Aim: To understand the clinical risk factors of staphylococcus aureus death in adult blood flow infection,and to provide reference for clinical diagnosis and treatment.Methods: Retrospective analysis of clinical data of patients with Staphylococcus aureus infection in the Northern Jiangsu People's Hospital.From 2013 to 2016,Antibacterial spectrum of bacteria cultured in vitro,sex,age,fatality rate,PCT,CRP,Lac,WBC,NE%,PLT,VAN-MIC were separate collected.SPSS 22.0 software was used to analyze the data,the measurement data were all t-test,and the classification variables were chi-square test.Results: From 2013 to 2016,193 patients were infected with Staphylococcus aureus.Among them,18 were discharged automatically,12 were transferred to hospital,6 were relapsed,5 were younger than 18 years old,and 152 were selected finally.There were 28 cases of community-acquired bloodstream infection with methicillin-sensitive staphylococcus aureus(CA-MSSA),20 cases survive,8 cases died,the mortality rate was 28.6 %;67 cases of hospital-acquired bloodstream infection with methicillin-sensitive staphylococcus aureus(HA-MSSA),60 cases survive,7 cases died,the mortality rate was 10.4 %;and there were 57 cases of hospital-acquired bloodstream infection with methicillin-resistant staphylococcus aureus(HA-MRSA),42 cases survive,15 cases died,and the mortality rate was 26.3 %.There was no community acquired MRSA strain.There were significant differences in overall mortality among the three groups(p=0.037),and the mortality rate in CA-MSSA group was significantly higher than that in HA-MSSA group(p=0.027),and the mortality rate in HA-MRSA group was significantly higher than that in HA-MSSA group(p = 0.021).There was no significant difference between CA-MSSA group and HA-MRSA group.No drug resistance to Vancomycin,Linezolid,Tigecycline and Nitrofurantoin was found in HA-MRSA strains which were positive in blood culture,and showed high resistance to Penicilling(98.25%),Erythromycin(85.96%),Clindamycin(80.70%),Ciprofloxacin(57.89%),Levofloxacin(52.63%)and Tetracycline(50.88 %).And MRSA resistance rate to Erythromycin,Levofloxacin,Tetracycline,Gentamycin,compound Neomycin,Clindamycin,Ciprofloxacin,Moxifloxacin was significantly higher than HA–MSSA,which has statistically significant.There was no significant difference in drug resistance between CA-MSSSA and HA-MSSA.MSSA showed high drug resistance to Penicilling,Erythromycin,Clindamycin and Ciprofloxacin in turn.Charlson score in the death group was significantly higher than that in the survival group in patients with blood flow infection CA-MSSA(t = 2.21,p = 0.036).The age,white blood cell count,procalcitonin,VAN-MIC value and ICU stay in the death group were higher than those in the survival group,which the difference was not statistically significant(p > 0.05).While the percentage of Neutrophils,C-reactive protein,ICU stay probability,fever days after admission,fever days after admission,antibiotic use rate were lower than those in the survival group,the difference was not statistically significant(p > 0.05).Among HA-MRSA patients with blood stream infection,the probability of admission to ICU and VAN–MIC values in the death group were significantly higher than those in the survival group(p = 0.01 and 0.04,respectively),which has statistically significant.The percentage of female,age,percentage of neutrophils and C-reactive protein in the death group were significantly higher than those in the survival group(p> 0.05).The difference was not statistically significant.Further more,the number of white blood cells,Procalcitonin,fever days after admission,antibiotic use rate,ICU days were lower than the survival group,the difference was not statistically significant(p > 0.05).Among HA-MSSA patients,the age,percentage of neutrophils,procalcitonin,ICU admission rate,VAN-MIC and ICU stay were significantly higher in the death group than those in the survival group,and the difference was not statistically significant(p > 0.05).While the proportion of women,white blood cells,procalcitonin,fever days after admission,antibiotic use rate were significantly lower than those in the survival group the difference was not statistically significant(p > 0.05).Conclusion: Compared with blood flow infection HA-MSSA,CA-MSSA and HA-MRSA infection can increase the mortality of patients,MRSA resistance was significantly higher than MSSA,showing multidrug resistance.Charlson score is an effective prognostic indicator in patients with blood flow infection of CA-MSSA.ICU and VAN-MIC values can be used as indicators to judge blood flow infection of MRSA.Clinicians can make diagnosis and treatment according to the relevant factors.