BACTEREMIA AT BOSTON-CITY-HOSPITAL - OCCURRENCE AND MORTALITY DURING 12 SELECTED YEARS (1935-1972), WITH SPECIAL REFERENCE TO HOSPITAL-ACQUIRED CASES
BACTEREMIA AT BOSTON-CITY-HOSPITAL - OCCURRENCE AND MORTALITY DURING 12 SELECTED YEARS (1935-1972), WITH SPECIAL REFERENCE TO HOSPITAL-ACQUIRED CASES
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DOI：
10.1093/infdis/132.3.316
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发表时间：
1975-01-01
影响因子：
6.4
通讯作者：
FINLAND, M
中科院分区：
文献类型：
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作者：
MCGOWAN, JE;BARNES, MW;FINLAND, M
对1972年波士顿市立医院所有血培养阳性的有临床意义的需氧病原体或真菌患者的发病率和死亡率、性别、年龄、接受内科或外科治疗以及致病微生物进行了分析。在1935年至1969年的11年间获得了类似的数据，以反映各种有效抗菌剂的引入和普遍使用。还比较了医院获得性菌血症感染（定义为在住院第三天或之后获得首次阳性血培养的感染）和社区获得性感染（定义为入院时或住院前两天内血培养阳性的感染）。1972年，男性的菌血症感染发病率（但不是病死率）明显高于女性。菌血症感染在内科的发生率是外科的两倍多，但病死率在外科略高，但不显着。菌血症最常见于最年轻（出生至9岁）和最年长（~60岁）的年龄组，而病死率在最年轻组最低，并随年龄的增加而增加，肺炎链球菌是最常见的菌血症病原体，其次依次为大肠埃希菌、克雷伯氏菌-肠杆菌和金黄色葡萄球菌。由沙门氏菌引起的病例病死率最低。其中以铜绿假单胞菌、变形杆菌和克雷伯氏菌-肠杆菌引起的感染率最高。所有12个选定年份的数据表明，在1950年代和1960年代的大部分时间里，菌血症感染的发病率都在上升，1969年和1972年有下降的证据。接受医疗服务的菌血症病例中最大比例是社区获得性的，而接受外科服务的大多数是医院获得性的;在医疗和外科服务方面，医院获得性感染率继续增加，最近减少的大多数是接受医疗服务的社区获得性病例。在所有情况下，医院获得性感染者的病死率明显高于社区获得性感染者。在1935年，约五分之一的菌血症感染病例和约30%的此类感染死亡病例发生在60岁左右的患者中。其余病例在30岁以下和30-59岁之间大致各占一半，但后一年龄组占所有死亡人数的一半。在随后的几年中，30岁以下患者的病例（特别是死亡）比例急剧下降，而60岁以下患者的病例和死亡人数增加到约占所有病例的一半，在选定的年份中，每年都超过60%（高达四分之三）。1935年，S.肺炎链球菌和β-溶血性链球菌占所有菌血症感染病例的一半以上，占所有此类感染死亡病例的近三分之二;金黄色葡萄球菌占病例的五分之一，占死亡的六分之一。在20世纪50年代，S.金黄色葡萄球菌感染增加，直到这种微生物占菌血症病例和死亡的三分之一以上，但这些比例在随后的几年中下降到仅占所有病例和死亡的八分之一。自1951年以来，革兰氏阴性杆菌在病例中所占的比例越来越大，现在占菌血症感染和此类感染死亡的主要原因。
The cases of all patients hospitalized at Boston City Hospital during 1972 who had blood cultures positive for a clinically significant, aerobic bacterial pathogen or forCandidawere analyzed with respect to incidence and mortality, sex, age, admission to medical or surgical services, and the causative organism. Similar data were obtained for 11 years between 1935 and 1969 selected to reflect the introduction and general use of various effective antibacterial agents. Comparisons were also made between hospital-acquired bacteremic infections (defined as those in which the first positive blood culture was obtained on or after the third day in the hospital) and community-acquired infections (defined as those with positive blood cultures on admission or within the first two days in the hospital). In 1972, the incidence of bacteremic infections (but not the case-fatality ratio) was significantly higher in males than in females. Bacteremic infections were more than twice as frequent on the medical than on the surgical services, but the case-fatality ratio was slightly but not significantly higher on the surgical services. Bacteremia was most frequent in the youngest (birth through nine years) and the oldest (~60 years) age groups, whereas the case-fatality ratio was lowest in the youngest group and increased with each decade of life.Streptococcus pneumoniaewas the most frequent organism causing bacteremia; next wereEscherichia coli,Klebsiella-Enterobacter, andStaphylococcus aureus, in that order. The case-fatality ratio was lowest in cases due to S. pneumoniae and highest in those caused byPseudomonas aeruginosa,Proteus, andKlebsiella-Enterobacter. The data for all 12 selected years indicate a rising incidence of bacteremic infections during the 1950s and most of the 1960s, with evidence of decline in 1969 and 1972. The greatest proportion ofbacteremic cases on the medical services were community-acquired, whereas the majority of those on the surgical services were hospital-acquired; on both the medical and the surgical services, the rates of hospital-acquired infections continued to increase, and most of the recent decrease was in community-acquired cases on medical services. Case-fatality ratios were significantly higher among those with hospital-acquired infections than among those with community-acquired infections in all instances. In 1935 about one-fifth of all cases of bacteremic infection and about 30% of deaths from such infections were in patients ~60 years old. The remaining cases were about equally divided among those <30 years old and those 30-59 years old, but one-half of all deaths were among the latter age group. In the ensuing years the proportion of cases (and particularly of deaths) in those <30 years old declined sharply, whereas cases and deaths in patients ~60 years old increased to about one-half of all cases and to more than 60% (up to three-fourths) of all deaths in each of the selected years. In 1935,S. pneumoniaeand β-hemolyticStreptococcusaccounted for more than half of all cases of bacteremic infection and for nearly two-thirds of all deaths from such infections;S. aureusaccounted for one-fifth of the cases and for one-sixth of the deaths. During the 1950s, the number ofS. aureusinfections increased until this organism accounted for more than one-third of the bacteremic cases and deaths, but these proportions decreased in ensuing years to only one-eighth of all cases and deaths. Gram-negative bacilli have accounted for increasing proportions of cases since 1951 and now predominate as causes of bacteremic infection and of deaths from such infections.