How to discriminate contamination from bloodstream infection due to coagulase-negative staphylococci: a prospective study with 654 patients
How to discriminate contamination from bloodstream infection due to coagulase-negative staphylococci: a prospective study with 654 patients
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DOI：
10.1111/j.1469-0691.2012.03964.x
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发表时间：
2012-09-01
影响因子：
14.2
通讯作者：
Widmer, A. F.
中科院分区：
文献类型：
--
作者：
Elzi, L.;Babouee, B.;Widmer, A. F.
Clin Microbiol Infect 2012; 18：E355 E361摘要凝固酶阴性葡萄球菌（CoNS）是血培养的常见污染物。我们的目的是评估全身炎症反应综合征（SIRS）标准与CoNS菌血症患者之间的区别真正的血流感染（BSI）和污染。对2003年至2007年期间在巴塞尔大学医院至少有一次CoNS阳性血培养的成人的临床和实验室参数进行了前瞻性评价。在3060例阳性血培养中，确定了654例CoNS菌血症。其中，232例（35%）被认为是真正的BSI，422例（65%）被认为是污染。总体而言，80%的研究参与者至少有一个SIRS标准，发热是最常见的，49%至少有两个SIRS标准。在多变量分析中，BSI的独立预测因子是发热或体温过低（OR 2.93，95% CI 1.914.5），心动过速（OR 2.29，95% CI 1.503.50），呼吸急促（OR 2.4，95% CI 1.304.43）、白细胞增多或白细胞减少（OR 4.15，95% CI 2.176.36）和存在中心静脉管路（OR 5.38，95% CI 3.258.88）。BSI的概率随着每个额外的SIRS标准而增加，范围从仅具有一个SIRS标准的患者的42.4%到具有两个SIRS标准的患者的56.7%，以及具有三个SIRS标准的患者的72.3%。如果患者至少有三个SIRS标准或两个SIRS标准和中心静脉导管，CoNS阳性血培养最有可能代表真正的BSI。这些简单的床旁标准可以指导治疗决策，减少糖肽类药物的使用。
Clin Microbiol Infect 2012; 18: E355E361 Abstract Coagulase-negative staphylococci (CoNS) are frequent contaminants of blood cultures. We aimed to evaluate the systemic inflammatory response syndrome (SIRS) criteria in patients with CoNS bacteraemia for discrimination between true bloodstream infection (BSI) and contamination. Prospective evaluation was carried out of clinical and laboratory parameters in adults with at least one positive blood culture with CoNS at the University Hospital of Basel between 2003 and 2007. Of 3060 positive blood cultures, 654 episodes of CoNS bacteraemia were identified. Of these, 232 (35%) were considered to be true BSI and 422 (65%) were considered to be contamination. Overall, 80% of study participants had at least one SIRS criterion, fever being the most common, and 49% had at least two SIRS criteria. In the multivariate analysis, independent predictors of BSI were fever or hypothermia (OR 2.93, 95% CI 1.914.5), tachycardia (OR 2.29, 95% CI 1.503.50), tachypnoea (OR 2.4, 95% CI 1.304.43), leucocytosis or leucopenia (OR 4.15, 95% CI 2.176.36) and the presence of a central venous line (OR 5.38, 95% CI 3.258.88). The probability of BSI increased with each additional SIRS criterion, ranging from 42.4% in patients with only one SIRS criterion to 56.7% for those with two criteria, and 72.3% for patients with three SIRS criteria. A positive blood culture with CoNS most likely represents true BSI if the patient has at least three SIRS criteria or two SIRS criteria and a central venous catheter. These simple bedside criteria may guide decision to treat, decreasing the use of glycopeptides.