Drug Resistance And Prognosis Risk Factors For Nosocomial Bloodstream Infections

Objective The objective of this study was to research the clinical characteristics,pathogen distribution,nosocomial bloodstream infection(n BSI)prognosis,and risk factors for n BSI.Methods Patients were treated at the First Affiliated Hospital of Zhejiang Chinese Medical University(Hangzhou Zhejiang,China)between January 2015 and December 2018.Patients were retrospectively studied with respect to clinical and microbiological data.The bacteria species,distribution,and drug resistance were analyzed.The univariate and multivariate logistic regression analysis was performed for the risk factors of nosocomial bloodstream infection.Results Our study included 704 episodes of n BSI during the four-year study period.The incidence rate was 4.11 per 1,000 admissions.Ninety-six point seven percent of n BSI were mono-microbial: Gram-negative bacteria(fifty-six point four percent),Gram-positive bacteria(thirty-three point four percent),and fungal(seven percent).The top three department of n BSI was the Intensive Care Unit(twenty-eight point eight percent),the Hematology Department(twenty point one percent),the Oncology Department(fifteen point five percent).Seventy-six point four percent patients were indwelling the deep venous catheter and 184 patients(twenty-six point four percent)were diagnosed with catheter related bloodstream infection.Of all the Escherichia coli isolates,forty-one point five percent were extended-spectrum?-lactamase-producing(ESBL)-positive.Fifty point nine percent of Klebsiella pneumoniae isolates were resistant to imipenem.Forty-two point one percent of Staphylococcus aureus isolates were methicillin-resistant.The overall 28-day mortality rate in all patients with n BSI was twenty-four point four percent.Univariate analysis: indwelling deep venous catheter,removal of venous catheter,parenteral nutrition,appropriate empirical therapy,SOFA score(?5)was associated with the prognosis of n BSI.Parenteral nutrition(PN)and sequential organ failure assessment(SOFA)scores(? 5)were closely related to the 28-day mortality of n BSI,while removal of venous catheter and appropriate empirical therapy were protective factors of 28-day mortality.Conclusion Gram-negative bacteria were the most frequent pathogen in nosocomial bloodstream infections.Timely removal of vein catheter(catheter retention time ? 7 days)and implementation of appropriate empirical therapy improved n BSI outcomes.