The clinical impact of bacteremia in complicated acute pyelonephritis
The clinical impact of bacteremia in complicated acute pyelonephritis
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DOI：
10.1097/00000441-200610000-00004
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发表时间：
2006-10-01
影响因子：
3.1
通讯作者：
Chung, Hsiao-Min
中科院分区：
文献类型：
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作者：
Hsu, Chih-Yang;Fang, Hua-Chang;Chung, Hsiao-Min
背景：菌血症被认为是几种感染性疾病中严重感染的替代标志。然而，目前尚不清楚复杂性急性肾盂肾炎（APN）患者的菌血症是否与严重感染相关。研究方法：我们进行了一项回顾性研究，以调查复杂的APN菌血症的存在和疾病严重程度之间的关系。为了做到这一点，我们回顾了2003年1月至2003年12月间在台湾高雄荣民总医院住院的128例诊断为复杂APN的患者的病历。在我们的分析中，我们比较了有菌血症和无菌血症患者的临床表现、治疗反应和结局。结果：128例患者中有54例（42%）为菌血症。与非菌血症患者相比，这组患者更常出现严重脓毒症或脓毒性休克（P < 0.001）。与菌血症相关的其他因素包括年龄、糖尿病、中性粒细胞计数中更多的带状形式、肾功能受损和血清白蛋白水平较低。使用多变量logistic回归分析，我们发现较低水平的血清白蛋白（比值比，0.18; 95%CI，0.05-0.65; P = 0.008）和严重脓毒症的存在（比值比，4.76; 95%CI，1.43-15.84; P = 0.011）是与菌血症相关的独立因素。治疗后，菌血症组比非菌血症组需要更长的时间才能退热（5.1 +/- 2.3 vs. 4.2 +/- 1.6天，P = 0.023）。此外，菌血症组静脉注射抗生素的平均时间更长，住院时间更长（P < 0.001）。多元Logistic回归分析显示，非大肠杆菌菌血症、存在尿路结石或肾积水、抗生素使用时间较短以及男性与6个月内尿路感染复发显著相关。结论：并发APN的菌血症提示病情严重，非大肠杆菌菌血症患者更易复发。我们的研究表明，菌血症确实是一个有用的严重疾病的临床指标，如果发现，应影响病人的管理。因此，我们建议所有复杂APN患者均应采集血培养样本。
Background: Bacteremia has been considered as a surrogate marker of severe infection in several infectious diseases. However, it remains uncertain whether the presence of bacteremia correlates with severe infection in patients with complicated acute pyelonephritis (APN). Methods: We performed a retrospective study to investigate the relationship between the presence of bacteremia and disease severity in complicated APN. To do this, we reviewed medical records from 128 patients diagnosed with complicated APN admitted to Kaohsiung Veterans General Hospital, Taiwan between January, 2003 and December, 2003. In our analysis, we compared clinical presentation, treatment response, and outcome in patients with and without bacteremia. Results: Fifty-four of 128 patients (42%) were bacteremic. This group of patients presented more frequently with severe sepsis or septic shock (P < 0.001), compared with nonbacteremic patients. Other factors that correlated with the presence of bacteremia were older age, diabetes mellitus, more band forms in neutrophil cell counts, impaired renal function, and a lower level of serum albumin. Using a multivariate logistic regression analysis, we show that lower levels of serum albumin (odds ratio, 0.18; 95% CI, 0.05-0.65; P = 0.008) and presence of severe sepsis (odds ratio, 4.76; 95% CI, 1.43-15.84; P = 0.011) were independent factors associated with bacteremia. Following treatment, the bacteremic group took a longer time to become defervescent than the nonbacteremic group (5.1 +/- 2.3 vs. 4.2 +/- 1.6 days, P = 0.023). Also, the bacteremic group had a greater mean duration of intravenous antibiotics administration and longer hospital stays (P < 0.001). Multiple logistic regression analysis shows that non-Escherichia coli bacteremia, presence of urolithiasis or hydronephrosis, shorter duration of antibiotics administration, and being male were significantly associated with recurrence of urinary tract infection within 6 months. Conclusion: Bacteremia in cases of complicated APN indicates a severe disease, which is more likely to recur in patients with non-E coli bacteremia. Our study showed that bacteremia is indeed a useful clinical indicator of severe disease and, if found, should influence patient management. Therefore, we recommend that blood culture samples should be taken in all patients with complicated APN.