Epidemiology and outcome of nosocomial and community-onset bloodstream infection
Epidemiology and outcome of nosocomial and community-onset bloodstream infection
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DOI：
10.1128/jcm.41.8.3655-3660.2003
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发表时间：
2003-08-01
影响因子：
9.4
通讯作者：
Doern, GV
中科院分区：
文献类型：
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作者：
Diekema, DJ;Beekmann, SE;Doern, GV
我们进行了一项血流感染的前瞻性研究，以确定与死亡率独立相关的因素。1999年2月至2000年7月，929个连续事件的血流感染在两个三级保健中心进行了研究。基于ICD-9的Charlson指数用于调整基础疾病。粗死亡率为24%（社区发病为14%，院内血流感染为34%）。血流感染导致的死亡率总体为17%（社区发病为10%，院内血流感染为23%）。多变量logistic回归分析显示，与院内死亡率的独立相关性如下：院内获得（优势比[OR.] 2.6，P < 0.0001），低血压（OR 2.6，P < 0.0001），无发热反应（P = 0.003），呼吸急促（OR 1.9，P = 0.001），白细胞减少或白细胞增多（总白色血细胞计数20，000，P = 0.003）、存在中心静脉导管（OR 2.0，P = 0.0002）和存在厌氧微生物（OR 2.5，P = 0.04）。即使调整了基础疾病和住院时间，血流感染的医院状况与总住院费用的增加密切相关（P < 0.0001）。尽管占所有血流感染的大约一半，但医院内血流感染占与血流感染相关的死亡率和成本的大部分。
We performed a prospective study of bloodstream infection to determine factors independently associated with mortality. Between February 1999 and July 2000, 929 consecutive episodes of bloodstream infection at two tertiary care centers were studied. An ICD-9-based Charlson Index was used to adjust for underlying illness. Crude mortality was 24% (14% for community-onset versus 34% for nosocomial bloodstream infections). Mortality attributed to the bloodstream infection was 17% overall (10% for community-onset versus 23% for nosocomial bloodstream infections). Multivariate logistic regression revealed the independent associations with in-hospital mortality to be as follows: nosocomial acquisition (odds ratio [OR.] 2.6, P < 0.0001), hypotension (OR 2.6, P < 0.0001), absence of a febrile response (P = 0.003), tachypnea (OR 1.9, P = 0.001), leukopenia or leukocytosis (total white blood cell count of 20,000, P = 0.003), presence of a central venous catheter (OR 2.0, P = 0.0002), and presence of anaerobic organism (OR 2.5, P = 0.04). Even after adjustments were made for underlying illness and length of stay, nosocomial status of bloodstream infection was strongly associated with increased total hospital charges (P < 0.0001). Although accounting for about half of all bloodstream infections, nosocomial bloodstream infections account for most of the mortality and costs associated with bloodstream infection.