Extraintestinal focal infections in adults with nontyphoid Salmonella bacteraemia:: predisposing factors and clinical outcome
Extraintestinal focal infections in adults with nontyphoid Salmonella bacteraemia:: predisposing factors and clinical outcome
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DOI：
10.1111/j.1365-2796.2006.01748.x
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发表时间：
2007-01-01
影响因子：
11.1
通讯作者：
Ko, W. -C.
中科院分区：
文献类型：
--
作者：
Chen, P. -L.;Chang, C. -M.;Ko, W. -C.
研究背景：本研究以台湾南部某医学中心1999年1月至2005年6月间发生NTS菌血症的129例患者为研究对象，其中51例（39.5%）合并EFIs。最常见的并发症是肌层动脉瘤，其次是胸膜肺感染和脊髓骨髓炎。与原发性菌血症患者相比，EFI患者的白细胞计数较高（P = 0.004），血清C反应蛋白水平较高（P < 0.0001）。EFIs的发生与较高的死亡率、更严重的脓毒症表现、更长的住院时间和抗菌治疗的持续时间相关。单因素分析显示糖尿病（P = 0.02）、高血压（P = 0.02）和慢性肺部疾病（P = 0.006）与EFI显著相关。然而，恶性肿瘤（P = 0.01）和免疫抑制治疗（P = 0.03）的患者不太可能发生EFI。多因素分析显示，年龄是影响EFI发生的独立因素[校正比值比（aOR）1.05; 95%可信区间（CI）1.02-1.07; P < 0.0001]，而恶性肿瘤与EFI呈负相关结论NTS菌血症患者中，老年人易发生EFI，且EFI的病死率和致残率较高。识别特定的宿主因素对于识别EFI是必不可少的，EFI通常需要早期手术干预和长期抗菌治疗。
Background In a medical center in southern Taiwan, patients aged >= 18 years with NTS bacteraemia between January 1999 and June 2005 were included for analysis.Results Of 129 patients, 51 (39.5%) were complicated with EFIs. The most common EFI was mycotic aneurysm, followed by pleuropulmonary infections and spinal osteomyelitis. Compared to patients with primary bacteraemia, those with EFIs had higher leucocyte counts (P = 0.004) and higher serum levels of C-reactive protein (P < 0.0001). The development of EFIs was associated with a higher mortality, more severe septic manifestations, longer hospital stays and duration of antimicrobial therapy. Univariate analysis revealed that diabetes mellitus (P = 0.02), hypertension (P = 0.02) and chronic lung disease (P = 0.006) were significantly associated with EFIs. However, patients with malignancy (P = 0.01) and immunosuppressive therapy (P = 0.03) were less likely to develop EFIs. On the basis of multivariate analysis, an independent factor for the occurrence of EFIs was age [adjusted odds ratio (aOR) 1.05; 95% confidence interval (CI) 1.02-1.07; P < 0.0001], whilst malignancy was negatively associated with EFIs (aOR 0.16; 95% CI 0.14-0.78; P = 0.01).Conclusion Amongst patients with NTS bacteraemia, EFIs often occurred in the aged, and were associated with a higher mortality and morbidity. Recognition of specific host factors is essential for identification of EFIs which often demand early surgical interventions and prolonged antimicrobial therapy.