Bacteremia and severe sepsis in adults: A multicenter prospective survey in ICUs and wards of 24 hospitals
Bacteremia and severe sepsis in adults: A multicenter prospective survey in ICUs and wards of 24 hospitals
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DOI：
10.1164/ajrccm.154.3.8810595
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发表时间：
1996-09-01
影响因子：
24.7
通讯作者：
Lepoutre, A
中科院分区：
文献类型：
--
作者：
BrunBuisson, C;Doyon, F;Lepoutre, A
为了研究菌血症与严重脓毒症之间的关系，并评估感染特征对严重脓毒症风险和菌血症结局的影响，我们对法国24家医院85,750名成人病房和重症监护病房（icu）住院患者进行了为期2个月的前瞻性调查，分析了所有临床显著的菌血症事件。每1000名成人住院患者中，菌血症和菌性严重败血症的发生率分别为9.8 （95% CI: 9.2至10.5）和2.6 (95% CI: 2.2至2.9)；这些比率在icu分别比病房高8倍和32倍。菌血症期间严重脓毒症的独立危险因素包括年龄（p < 0.001）和腹腔内（p < 0.001）、肺（p < 0.001）、神经脑膜（p = 0.004）或多种菌血症来源（p < 0.001），但不包括涉及的微生物类别。菌血症后28天的死亡概率为25% (95% CI: 23%至29%)，菌血症严重败血症患者的死亡概率为54% （95% CI: 48%至61%）。菌血症后的死亡风险随着年龄的增长而增加（p < 0.001），一种迅速或最终致命的潜在疾病（p < 0.001），严重败血症（p < 0.001），休克（p = 0.03），以及与其他微生物相比，由凝固酶阴性葡萄球菌以外的革兰氏阳性菌引起的感染（p < 0.001）。原发性尿路感染源与较好的预后相关（p = 0.03）。我们的结论是，尽管感染源影响严重败血症的风险和菌血症的结果，但感染的微生物学特征仅影响结果，革兰氏阴性菌和凝固酶阴性葡萄球菌的风险低于其他菌。
To examine the relationships between bacteremia and severe sepsis and assess the influence of characteristics of infection on the risk of severe sepsis and outcome of bacteremia, we analyzed all clinically significant episodes of bacteremia occurring during a 2-mo prospective survey of 85,750 admissions to adult wards and intensive care units (ICUs) of 24 hospitals in France. Incidence rates of bacteremia and of bacteremic severe sepsis were 9.8 (95% CI: 9.2 to 10.5) and 2.6 (95% CI: 2.2 to 2.9), respectively, per 1,000 adult admissions; these rates were eight and 32 times higher in ICUs than in wards, respectively. Independent risk factors for severe sepsis during bacteremia included age (p < 0.001) and an intraabdominal (p < 0.001), pulmonary (p < 0.001), neuromeningeal (p = 0.004), or multiple (p < 0.001) source of bacteremia, but not categories of organisms involved. The probability of death at 28 d after bacteremia was 25% (95% CI: 23% to 29%), and was 54% (95% CI: 48% to 61%) in patients with bacteremic severe sepsis. The risk of death after bacteremia increased with age (p < 0.001), a rapidly or ultimately fatal underlying disease (p < 0.001), and the presence of severe sepsis (p < 0.001), shock (p = 0.03), and infection caused by gram-positive organisms other than coagulase-negative staphylococci, relative to other organisms (p < 0.001). A primary urinary tract source of infection was associated with a better prognosis (p = 0.03). We conclude that whereas sources of infection influence both the risk of severe sepsis and the outcome of bacteremia, the microbiologic characteristics of infection influence only the outcome, with gram-negative organisms and coagulase-negative staphylococci posing a lesser risk than other organisms.