Predictors of positive blood cultures in critically ill patients: a retrospective evaluation.
Predictors of positive blood cultures in critically ill patients: a retrospective evaluation.
复制标题
危重患者血培养阳性的预测因素：回顾性评估。
DOI：
10.3325/cmj.2012.53.30
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发表时间：
2012-02-15
影响因子：
1.9
通讯作者：
Perren A
中科院分区：
文献类型：
--
作者：
Previsdomini M;Gini M;Cerutti B;Dolina M;Perren A
确定危重患者菌血症的预测因素，评估血培养对预后的影响，并确定在同时进行抗生素治疗的情况下出现突破性菌血症的条件。在瑞士贝林佐纳圣乔瓦尼医院外科重症监护病房（ICU）进行了为期两年（2007-2008年）的描述性回顾性研究。231例患者中45例（19.5%）血培养阳性。血培养阳性的预测因子为降钙素原水平升高（>2µg/L, P < 0.001）、严重程度评分较高（简化急性生理评分II>43, P = 0.014；序期器官衰竭评估>4.0,P < 0.001）和肝衰竭（P = 0.028）。菌血症患者住院时间较长（31天vs 21天，P = 0.058），但死亡率与无菌血症患者无显著差异。发热（0℃~ 38.5℃）仅呈血培养阳性率增高趋势（P = 0.053）。血培养阳性率不受同期抗生素治疗的影响。预测阳性血培养结果仍然是一项非常困难的任务。在我们的分析中，20%接受血液培养的ICU患者的血培养呈阳性，阳性结果随着降钙素原水平升高、肝功能衰竭和严重程度评分升高而增加。在抗生素治疗开始后第4天和手术后第5天分别进行血培养>和>，可以发现导致新的感染并发症的病原体。
To identify predictors of bacteremia in critically ill patients, to evaluate the impact of blood cultures on the outcome, and to define conditions for breakthrough bacteremia despite concurrent antibiotic treatment. A descriptive retrospective study was performed over a two-year period (2007-2008) in the medico-surgical Intensive Care Unit (ICU) of the San Giovanni Hospital in Bellinzona, Switzerland. Forty-five out of 231 patients (19.5%) had positive blood cultures. Predictors of positive blood cultures were elevated procalcitonin levels (>2 µg/L, P < 0.001), higher severity scores (Simplified Acute Physiology Score II>43, P = 0.014; Sequential Organ Failure Assessment >4.0, P < 0.001), and liver failure (P = 0.028). Patients with bacteremia had longer hospital stays (31 vs 21 days, P = 0.058), but their mortality was not different from patients without bacteremia. Fever (t > 38.5°C) only showed a trend toward a higher rate of blood culture positivity (P = 0.053). The rate of positive blood cultures was not affected by concurrent antibiotic therapy. The prediction of positive blood culture results still remains a very difficult task. In our analysis, blood cultures were positive in 20% of ICU patients whose blood was cultured, and positive findings increased with elevated procalcitonin levels, liver failure, and higher severity scores. Blood cultures drawn >4 days after the start of antibiotic therapy and >5 days after surgery could detect pathogens responsible for a new infection complication.
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影响因子：
120.7
作者：
PITTET, D;TARARA, D;WENZEL, RP
通讯作者：
WENZEL, RP
影响因子：
120.7
作者：
BRUNBUISSON, C;DOYON, F;REGNIER, B
通讯作者：
REGNIER, B
影响因子：
--
作者：
Koivula, Irma;Hamalainen, Sari;Juutilainen, Auni
通讯作者：
Juutilainen, Auni
影响因子：
120.7
作者：
LEGALL, JR;LEMESHOW, S;SAULNIER, F
通讯作者：
SAULNIER, F
影响因子：
9.6
作者：
Mueller, Fabian;Christ-Crain, Mirjam;Schuetz, Philipp
通讯作者：
Schuetz, Philipp