Multiple-organism bacteremia in the surgical intensive care unit: a sign of intraperitoneal sepsis.
Multiple-organism bacteremia in the surgical intensive care unit: a sign of intraperitoneal sepsis.
复制标题
外科重症监护病房中的多生物体菌血症：腹膜内败血症的征兆。
作者：
A. Ing;A. P. McLean;J. Meakins
英国皇家维多利亚医院外科重症监护室对多菌血症(MOB)进行了研究，其定义为两种或两种以上微生物在同一血液培养中生长。在1977年和1978年的两年中，83名患者发生了125次菌血症；其中，27名患者出现了32次暴乱。与MOB相关的死亡率为48%，而血液中只有一种微生物的患者死亡率为25%(P<0.025)。三名患者有两次暴徒发作，一名患者有三次暴动；全部死亡。令人惊讶的是，两名患者的病因是血管内装置。两名有四次暴动的患者有严重烧伤，而吸入性肺炎和感染的截肢残端又有两次。在其余21例患者(78%)的24次MOB(75%)中，所有患者都有腹膜内病理结果。在这些病例中，19例(59%)的发作明显与腹膜内败血症有关。其余5例似乎与腹膜内原因有关，但尚未得到证实。类杆菌和表皮葡萄球菌的发生率无差异。肠球菌和大肠埃希菌的发生率明显较高(P均<0.005)，且以多菌血症和单菌血症为主。多菌体菌血症与死亡率的增加有关，其起源具有多菌感染的特征。最重要的来源是腹膜内，MOB的发生应该提醒外科医生注意腹膜内脓毒症的可能性。
Multiple-organism bacteremia (MOB), as defined by the growth of two or more organisms in the same blood culture, was studied in the surgical intensive care unit at the Royal Victoria Hospital. Over the 2 years encompassing 1977 and 1978, there were 125 bacteremic episodes in 83 patients; of this total, 32 episodes of MOB were present in 27 patients. The mortality rate associated with MOB was 48% compared to 25% in those patients with a single organism in their blood (P less than 0.025). Three patients had two episodes of MOB, and one had three episodes; all died. The etiology in two patients was, surprisingly, intravascular devices. Two patients with four episodes of MOB had severe burns, whereas aspiration pneumonia and an infected amputation stump accounted for two more episodes. In the remaining 21 patients (78%) with 24 episodes of MOB (75%), all had intraperitoneal pathologic findings. Of these cases, 19 (59%) episodes were clearly related to intraperitoneal sepsis. The remaining five appeared related to intraperitoneal causes but were without confirmation. There was no difference in the incidence of Bacteroides and Staphylococcus epidermidis. The incidences of enterococci and Escherichia coli were significantly higher (P less than 0.005 for both) and dominant in multiple- versus single-organism bacteremia. Multiple-organism bacteremia is associated with an increased mortality rate, with origins characteristic of polymicrobial infections. The most important source is intraperitoneal and the occurrence of MOB should alert the surgeon to the likelihood of intraperitoneal sepsis.