Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment. Analysis of 189 episodes.
Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment. Analysis of 189 episodes.
复制标题
铜绿假单胞菌菌血症的流行病学和结果，特别强调抗生素治疗的影响。
DOI：
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发表时间：
1996
影响因子：
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通讯作者：
M. T. J. Anta
中科院分区：
文献类型：
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作者：
F. Vidal;J. Mensa;M. Almela;J. Martínez;F. Marco;C. Casals;J. Gatell;E. Soriano;M. T. J. Anta
客观化
评估铜绿假单胞菌菌血症的发病率、患者的基本情况、死亡率和与不良预后相关的因素的趋势。
患者和方法
对1991年1月1日至1994年12月31日连续189例铜绿假单胞菌菌血症的病历进行了前瞻性评估。记录相关的危险因素、治疗和结果。
结果
铜绿假单胞菌菌血症占菌血症总数的5.7%，占院内菌血症的6.9%，占院内革兰氏阴性菌血症的23.6%。每1000个出血量中有1.5次发作。这些数字略低于10年前在我们医院的记录。人类免疫缺陷病毒感染是最常见的基础疾病(28/189[15%])。总死亡率为18%(34/189)。存在致命的基础疾病(P<；.001)、手术(P=.001)、肺炎(P=.02)和严重脓毒症(P<；.001)与预后不良有关，这些变量的患者死亡率分别为28%、28%、47%和62%。只有当静脉导管相关性菌血症患者的亚组被排除在分析之外时，存在不适当的决定性抗菌治疗才成为预测死亡的独立因素(P=0.04)。接受2种或更多体外抗铜绿假单胞菌抗生素的患者的存活率并不比只接受1种抗生素的患者高。中性粒细胞减少与死亡率的增加无关。集落刺激因子的使用不影响中性粒细胞减少患者的预后。
结论
本院铜绿假单胞菌菌血症发生率略有下降。人类免疫缺陷病毒疫情的出现对流行病学和死亡率都产生了相当大的影响。严重的基础疾病、手术、肺炎，尤其是严重的败血症与不良预后相关。排除静脉导管相关性铜绿假单胞菌菌血症的患者，适当的抗菌治疗是获得良好结果的关键。使用一种有效的抗生素似乎就足够了。
OBJECTIVE
To evaluate the trend in incidence of Pseudomonas aeruginosa bacteremia, underlying conditions of patients, mortality rate, and factors associated with poor outcome.
PATIENTS AND METHODS
Medical charts of 189 consecutive episodes of P aeruginosa bacteremia, detected between January 1, 1991, and December 31, 1994, were prospectively evaluated. Associated risk factors, treatment, and outcome were recorded.
RESULTS
Pseudomonas aeruginosa bacteremia represented 5.7% of the total number of bacteremias, 6.9% of nosocomial bacteremias, and 23.6% of nosocomial gram-negative bacteremias. There were 1.5 episodes per 1000 discharges. These numbers were slightly lower than those recorded at our hospital 10 years earlier. Human immunodeficiency virus infection was the most frequent underlying disease (28/189 [15%]). Overall mortality was 18% (34/189). The presence of fatal underlying disease (P < .001), surgery (P = .001), pneumonia (P = .02), and severe sepsis (P < .001) were associated with poor prognosis, the mortality of the patients with these variables being 28%, 28%, 47%, and 62%, respectively. The presence of inappropriate definitive antimicrobial treatment became an independent factor predictive of death (P = .04) only when the subset of patients with intravenous catheter-associated bacteremia was excluded from the analysis. The survival rate was no greater in patients who received 2 or more antibiotics active in vitro against P aeruginosa than in those who received only 1. Neutropenia was not associated with increased mortality. The use of colony-stimulating factors did not affect the outcome of the neutropenic patients.
CONCLUSIONS
The rate of P aeruginosa bacteremia is falling slightly at our hospital. The emergence of the human immunodeficiency virus epidemic has had a considerable impact on both epidemiology and mortality. The presence of severe underlying disease, surgery, pneumonia, and, especially, severe sepsis are associated with a poor outcome. With the exclusion of patients with intravenous catheter-associated P aeruginosa bacteremia, the administration of an appropriate antimicrobial therapy is essential to a good outcome. Treatment with 1 active antibiotic seems to be sufficient.