Clinical prognostic factors for time to positivity in cancer patients with bloodstream infections
Clinical prognostic factors for time to positivity in cancer patients with bloodstream infections
复制标题
血流感染癌症患者阳性时间的临床预后因素
DOI：
10.1007/s15010-016-0890-2
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发表时间：
2016-10-01
期刊：
影响因子：
7.5
通讯作者：
Zhang, Sihe
中科院分区：
文献类型：
--
作者：
Zhang, Qing;Li, Ding;Zhang, Sihe
目的：近几年来，阳性时间（TTP）作为一种简单、快速的方法被用于进一步表征菌血症的程度。然而，TTP的预后因素在癌症患者的血流感染很少被研究。本研究的目的是探讨TTP涉及各种孤立的有机体在cancer patient.Methods的临床因素，我们分析了386例血流感染（BSIs）的患者或没有癌症在19个月期间。收集了有关年龄、性别、肿瘤类型、ICU住院时间、微生物、多药耐药（MDR）、TTP和结局的信息。结果肝细胞癌、胃肠癌和肺癌患者肠杆菌科细菌的平均TTP均短于非癌患者（9.86 ± 3.22，10.05 ± 3.47，8.85 ± 2.78 vs 13.11 ± 5.37 h）。肺癌患者非发酵杆菌的平均TTP（12.37 +/- 5.96 h）和血液病（8.72 ± 4.21小时）也比非癌症患者短（20.74 +/- 2.46小时），葡萄球菌分离株的平均TTP在非癌症患者之间存在显著差异（22.06 ± 3.71 h）和血液病患者（11.93 ± 5.44 h）。根据多变量分析，良性肿瘤的存在仅在葡萄球菌组中是长TTP的显著预后因素（OR 0.076，95%CI 0.014-0.412）。MDR（OR 2.178，95%CI 1.196-4.239）是肠杆菌科菌组TTP较短的独立显著预测因子，也是非发酵杆菌和葡萄球菌组TTP较长的显著临床因素（OR 5.037，95%CI 1.065-23.82; OR 0.167，95%CI 0.059-0.474）。结论阳性时间可为临床常见病原体的鉴别诊断和预后提供有用的信息。这些信息可能有助于临床医生根据临床因素分析及时使用正确的抗生素治疗患有BSI的癌症患者。
Purpose Time to positivity (TTP) has been used in recent years as a simple and rapid method for the additional characterization of the degree of bacteremia. However, prognostic factors for TTP in cancer patients with bloodstream infections have rarely been studied. The aim of this study was to investigate the clinical factors for TTP involving various isolated organisms in cancer patients.Methods We analyzed 386 episodes of bloodstream infections (BSIs) in patients with or without cancer during a 19 month period. Information on age, gender, tumor type, ICU stay, organisms, multidrug resistance (MDR), TTP and outcome was collected. Multivariate logistic regression analysis was performed.Results The mean TTP of Enterobacteriaceae in patients with hepatocellular carcinoma, gastroenterological cancer, and lung cancer was shorter than in non-cancer patients (9.86 +/- 3.22, 10.05 +/- 3.47, 8.85 +/- 2.78 vs 13.11 +/- 5.37 h). The mean TTP of nonfermentative bacilli in patients with lung cancer (12.37 +/- 5.96 h) and hematologic diseases (8.72 +/- 4.21 h) was also shorter than in non-cancer patients (20.74 +/- 2.46 h), and the mean TTP of Staphylococcus isolates was significantly different between non-cancer patients (22.06 +/- 3.71 h) and hematologic disease patients (11.93 +/- 5.44 h). The presence of a benign tumor was a significant prognostic factor for a long TTP only in the Staphylococci group (OR 0.076, 95 % CI 0.014-0.412), according to multivariate analysis. MDR (OR 2.178, 95 % CI 1.196-4.239) was an independent significant predictor in the Enterobacteriaceae group, with a short TTP, and it was also a significant clinical factor for a long TTP in nonfermentative bacilli and the Staphylococci group (OR 5.037, 95 % CI 1.065-23.82; OR 0.167, 95 % CI 0.059-0.474).Conclusion Time to positivity provides useful diagnostic and prognostic information for the differentiation of frequently isolated organisms. This information may help clinicians to use the correct antibiotics in a timely manner to treat cancer patients with BSIs based on clinical factor analysis.