Anaerobic Bacteremia: Impact of Inappropriate Therapy on Mortality
Anaerobic Bacteremia: Impact of Inappropriate Therapy on Mortality
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DOI：
10.3947/ic.2016.48.2.91
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发表时间：
2016-06-01
影响因子：
4.2
通讯作者：
Lee, Kyungwon
中科院分区：
文献类型：
--
作者：
Kim, Jieun;Lee, Yangsoon;Lee, Kyungwon
背景：厌氧菌血症（AB）的发病率和死亡率的调查具有临床意义，但其发病率和死亡率的调查并不多见，报告因时期和机构的不同而不同。因此，目前有必要分析AB的发病率及与死亡率相关的危险因素，评估AB的临床结局。材料与方法：回顾性分析某大学医院2012年AB患者及血培养厌氧菌的特点。分析危险因素与患者28天死亡率的相关性。结果：2012年共从70例菌血症患者血液中分离出非重复厌氧菌70株。心血管病史作为宿主危险因素的单因素和多因素分析均有统计学意义（P = 0.0344）。虽然在单因素和多因素分析中，不适宜治疗的差异无统计学意义，但不适宜治疗的患者菌血症生存率明显低于适宜治疗的患者（风险比为5.4；95%可信区间为1.7 ~ 16.9;P = 0.004）。最常见的分离菌是脆弱拟杆菌（32株，46%），其次是泰氏拟杆菌（10.14%）和非产气荚膜梭状芽胞杆菌（7.10%）。结论：2012年AB的发病率为2.3%（每100名血培养阳性患者中AB患者数），临床显著AB患者的死亡率为21.4%。此外，AB常见于恶性肿瘤患者，治疗不当患者的AB生存率明显低于治疗得当患者。
Background: Investigation on incidence and mortality of anaerobic bacteremia (AB) is clinically relevant in spite of its infrequent occurrence and not often explored, which report varies according to period and institutions. Therefore, it is necessary to analyze the incidence and risk factors related to mortality and assess clinical outcomes of AB in current aspect.Materials and Methods: Characteristics of AB patients and anaerobic bacteria from blood culture at a university hospital in 2012 were reviewed retrospectively. The correlation between risk factors and 28-day patient mortality was analyzed.Results: A total of 70 non-duplicated anaerobic bacteria were isolated from blood of 70 bacteremia patients in 2012. The history of cardiovascular disease as host's risk factor was statistically significant (P = 0.0344) in univariate and multivariate analysis. Although the inappropriate therapy was not statistically significant in univariate and multivariate analysis, the survival rate of bacteremia was significantly worse in patients who had inappropriate therapy compared with those underwent appropriate therapy (hazard ratio, 5.4; 95% confidence interval, 1.7-16.9; P = 0.004). The most frequently isolated organism was Bacteroides fragilis (32 isolates, 46%), followed by Bacteroides thetaiotaomicron (10, 14 %), and non-perfringens Clostridium (7, 10%).Conclusion: The incidence of AB in 2012 was 2.3% (number of AB patients per 100 positive blood culture patients) and the mortality rate in patients with clinically significant AB was 21.4%. In addition, AB was frequently noted in patients having malignancy and the survival rate of AB was significantly worse in patients who received inappropriate therapy compared with those underwent appropriate therapy.