Early deaths in bloodstream infections: a population-based case series
Early deaths in bloodstream infections: a population-based case series
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DOI：
10.3109/23744235.2015.1131329
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发表时间：
2016-05-03
影响因子：
5.8
通讯作者：
Lyytikainen, Outi
中科院分区：
文献类型：
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作者：
Kontula, Keiju S. K.;Skogberg, Kirsi;Lyytikainen, Outi
血液感染（BSI）中的显著部分死亡先前已被证明发生在采集首个阳性血培养标本后2天内。本研究的目的是分析导致早期死亡的BSI患者的特征和病原体，以探索预防的可能性。2007年赫尔辛基和乌乌西马地区（人口= 150万）的BSI患者是从国家传染病登记册（n = 2181）中确定的，他们在人口信息系统（n = 76）首次阳性血培养后2天内死亡。在早期致死性BSI中，42例（55%）为社区获得性（CA-BSI），34例（45%）为医疗保健相关性（HA-BSI）。71%的HA-BSI和60%的CA-BSI的Charlson合并症指数为中度至高度（指数>= 3）。CA-BSI中最常见的病原体是肺炎链球菌（29%）和大肠杆菌（24%），HA-BSI中最常见的病原体是铜绿假单胞菌（24%）和金黄色葡萄球菌（18%）。呼吸道（50%）是最常见的感染部位。经验性抗菌治疗在CA-BSI中比HA-BSI更常见（81% vs 41%，p < 0.001），但CA-BSI的治疗延迟时间更长。大多数早期死亡的BSI患者有严重的合并症。S.肺炎球菌感染占CA-BSI的三分之一，突出了肺炎球菌疫苗在预防中的潜在作用。早期识别BSI及其起源（CA-BSI vs HA-BSI）至关重要。需要持续监测医院病原微生物和耐药趋势的数据，以提出BSI经验性抗菌治疗指南。
A notable portion of deaths in bloodstream infections (BSI) have previously been shown to occur within 2 days after taking the first positive blood culture specimen. The aim of this study was to analyse patients' characteristics and causative pathogens of BSIs, leading to early deaths in order to explore possibilities for prevention. Patients with BSI in Helsinki and Uusimaa region (population = 1.5 million) in 2007 were identified from the National Infectious Disease Register (n = 2181) and their deaths within 2 days after the first positive blood culture from the Population Information System (n = 76). Of the early fatal BSIs, 42 (55%) were community-acquired (CA-BSI) and 34 (45%) healthcare-associated (HA-BSI). Charlson comorbidity index was moderate-to-high (index >= 3) in 71% of HA-BSIs and 60% of CA-BSIs. The most common pathogens in CA-BSIs were Streptococcus pneumoniae (29%) and Escherichia coli (24%) and in HA-BSIs Pseudomonas aeruginosa (24%) and Staphylococcus aureus (18%). The respiratory tract (50%) was the most common focus of infection. Empiric antimicrobial treatment was more often appropriate in CA-BSIs vs HA-BSIs (81% vs 41%, p < 0.001), but treatment delays were longer in CA-BSIs. The majority of the BSI patients who died early had severe comorbidities. S. pneumoniae accounted for one third of CA-BSIs, highlighting the potential role of pneumococcal vaccines in prevention. Early recognition of BSI and its origin (CA-BSI vs HA-BSI) is crucial. Continuous surveillance data on causative microbes and resistance trends in hospitals is needed to propose guidelines for empiric antimicrobial therapy of BSIs.