Nursing home-acquired bloodstream infection
Nursing home-acquired bloodstream infection
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DOI：
10.1086/502502
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发表时间：
2005-10-01
影响因子：
4.5
通讯作者：
Mylotte, JM
中科院分区：
文献类型：
--
作者：
Mylotte, JM
目的：本文回顾北美已发表的关于疗养院获得性血友病的研究，以确定在过去20年中这种感染的流行病学是否有变化，并确定疗养院环境中血培养的适应症。方法：检索Medline从1980年到2003年8月期间。疗养院获得性BSI的发生率很低(每1000个住院护理日有0.3例发病)。在过去的二十年中，BSI的来源几乎没有变化，尿路感染约占发病的50%。细菌学在过去的20年中也没有实质性的变化；大约50%的病例中分离到了革兰氏阴性杆菌，而大肠杆菌是最常见的分离生物。在1997年至2000年期间的最新研究中，对氟喹诺酮类药物、广谱青霉素类和头孢菌素类药物的耐药性在革兰氏阴性血液分离株中并不常见；MRSA是导致疗养院获得性BSI的最常见耐药微生物。病死率在过去20年变化不大，尿路感染的病死率最低，肺炎的病死率最高。结论：疗养院获得性BSI的流行病学在过去20年中变化不大。鉴于BSI的低发生率和血培养阳性结果的低总体产率(可能
OBJECTIVES: This article reviews published studies of nursing home-acquired BSI in North America to determine whether there have been changes in the epidemiology of this infection in the past 20 years and to define indications for blood cultures in the nursing home setting.METHODS: A Medline search was conducted for the period from 1980 to August 2003.RESULTS: Seven studies of nursing home-acquired BSI were identified. The incidence of nursing home-acquired BSI was low (0.3 episode per 1,000 resident care-days). Sources of BSI changed little during the past two decades, with urinary tract infection representing approximately 50% of the episodes. The bacteriology also did not change substantially during the past 20 years; gram-negative bacilli were isolated in approximately 50% of the episodes and Escherichia coli was the most commonly isolated organism. In the most recent study, covering the period 1997-2000, resistance to fluoroquinolones and broad-spectrum penicillins and cephalosporins was uncommon among gram-negative blood isolates; MRSA was the most common resistant organism causing nursing home-acquired BSI. Case-fatality rates changed little during the past 20 years; urinary tract infection was associated with the lowest mortality and pneumonia had the highest case-fatality rate.CONCLUSION: There has been little change in the epidemiology of nursing home-acquired BSI in the past 20 years. Given the low incidence of BSI and the low overall yield of positive results of blood cultures (probably