Clostridial bacteremia in the community hospital
Clostridial bacteremia in the community hospital
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DOI：
10.1080/00365540050164173
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发表时间：
2000-01-01
影响因子：
--
通讯作者：
Silvers, MJ
中科院分区：
文献类型：
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作者：
Haddy, RI;Nadkarni, DD;Silvers, MJ
在社区医院厌氧性感染的研究并不普遍。本研究的目的是确定梭状菌血症的人口统计学因素、进入途径和潜在疾病，并确定适当的（推荐的）治疗是否有效，仅回顾了美国佛罗里达州1家医院和美国俄亥俄州代顿4家医院的42例梭状菌血症患者的医疗记录。14例（33.3%）患者有梭菌微生物，这些微生物是在多微生物分离物培养中分离出来的，只有大约一半的患者在菌血症开始时发烧，只有略多于一半的患者白细胞计数升高。微生物最常见的进入途径为胃肠道（42.9%）、未知（35.7%）和皮肤（16.7%），最常见的基础疾病为晚期恶性肿瘤（31.0%）、糖尿病（14.3%）、不明（12.0%）和急性胆囊炎（9.5%）。死亡率为23.8%。只有约一半的患者及时开始适当的治疗，适当（推荐）治疗对生存率无显著影响（p = 0.469）。梭菌感染和菌血症在社区医院最常见于重症患者。梭状芽孢杆菌通常在其他细菌病原体阳性的血液培养物中培养，而对梭状芽孢杆菌的适当治疗并不影响患者的生存，这一事实使梭状芽孢杆菌的重要性和致病性受到质疑。另一方面，如果半数的菌血症患者没有考虑到梭菌菌血症，则可能忽略了更惰性的梭菌感染。
Anaerobic infections are not commonly studied in the community hospital. The aim of this study was to determine demographic factors, the portals of entry and underlying disorders for clostridial bacteremia and to determine whether appropriate (recommended) treatment is effective, Medical records mere reviewed for 42 patients with clostridial bacteremia at 1 Florida, USA, hospital and 4 Dayton, Ohio, USA, hospitals. Fourteen (33.3%) of the patients had clostridial micro-organisms that were isolated in cultures with polymicrobial isolates, Only about half of the patients had fever at the onset of their bacteremia and only slightly more than half had elevated leukocyte counts. The most common portals of entry for the micro-organisms were gastrointestinal (42.9%), unknown (35.7%) and skin (16.7%), The most common underlying disorders were advanced malignancy (31.0%), diabetes mellitus (14.3%), none determined (12.0%) and acute cholecystitis (9.5%). The mortality rate was 23.8%. Timely appropriate treatment was started in only about half of the instances, Appropriate (recommended) treatment did not significantly affect survival (p = 0.469). Clostridial infections and bacteremia exist in the community hospital most commonly in severely ill patients. The fact that clostridia are commonly cultured in blood cultures positive for other bacterial pathogens and that appropriate treatment for clostridia did not affect patient survival, call into question the significance and pathogenicity of clostridial organisms. On the other hand, if clostridial bacteremia was not considered in half these patients with bacteremia, it is possible that more indolent clostridial infections are being overlooked.