Garrouste-Orgeas M, Chevret S, Mainardi J L, Timsit J F, Misset B, Carlet J
Service de Réanimation Polyvalente, Hôpital Saint Joseph, Paris, France.
J Hosp Infect. 2000 Mar;44(3):206-13. doi: 10.1053/jhin.1999.0681.
A one-year, prospective, two-observational cohort study was performed to evaluate the incidence and outcome in hospitalized patients (ICU and non-ICU) of nosocomial bacteraemia, and to assess its prognostic value in the ICU group. A group of 18 098 hospitalized patients and a group of 291 consecutive ICU patients were followed. Prognostic factors were determined using single and multivariable analyses. 109 (90 non-ICU and 19 ICU) patients developed 118 nosocomial bacteraemic episodes. The incidence of nosocomial bacteraemia was 6.0 per 1000 admissions (95% confidence interval (CI): 5-7%) and 65 per 1000 admissions in ICU patients (95% CI: 4.5-8.5%). Gram-positive and Gram-negative bacteria were 63/133 (47%) and 70/133 (53%) of the isolated micro-organisms respectively. Crude mortality rates were 41/109 (38%) with adverse outcome associated with mechanical ventilation (OR: 3.6; 95% CI: 1.4-9.2, P =0.01), neutropenia (OR: 7.7; 95% CI: 0.8-73.1;P =0.07) while gastro-intestinal surgery was associated with an improved outcome (OR: 0.4; 95% CI: 0.16-0.96;P =0.04). Of the 291 ICU patients, 19 acquired 22 episodes of nosocomial bacteraemia, and 18 were referred from the wards with documented nosocomial bacteraemia. Of these 37 bacteraemic patients, 17 (46%) died. When adjusting for predictors of death (SAPS II>/=40, cardiac and neurological failure), nosocomial bacteraemia markedly influence the outcome in ICU patients (OR: 3.4; 95% CI: 1.3-8.7;P =0.010). This study suggests that the outcome of nosocomial bacteraemia in hospitalized patients is poor in ventilated and neutropenic patients and that nosocomial bacteraemia per se influenced outcome in ICU patients.
进行了一项为期一年的前瞻性双观察队列研究，以评估住院患者（重症监护病房和非重症监护病房）医院获得性菌血症的发病率和结局，并评估其在重症监护病房组中的预后价值。对一组18098例住院患者和一组291例连续的重症监护病房患者进行了随访。使用单变量和多变量分析确定预后因素。109例（90例非重症监护病房患者和19例重症监护病房患者）发生了118次医院获得性菌血症发作。医院获得性菌血症的发病率为每1000例入院患者6.0例（95%置信区间（CI）：5-7%），重症监护病房患者为每1000例入院患者65例（95%CI：4.5-8.5%）。革兰氏阳性菌和革兰氏阴性菌分别占分离微生物的63/133（47%）和70/133（53%）。粗死亡率为41/109（38%），不良结局与机械通气相关（比值比：3.6；95%CI：1.4-9.2，P=0.01），与中性粒细胞减少相关（比值比：7.7；95%CI：0.8-73.1；P=0.07），而胃肠道手术与结局改善相关（比值比：0.4；95%CI：0.16-0.96；P=0.04）。在291例重症监护病房患者中，19例发生了22次医院获得性菌血症发作，18例从病房转入，有记录的医院获得性菌血症。在这37例菌血症患者中，17例（46%）死亡。在对死亡预测因素（简化急性生理学评分II>/=40、心脏和神经功能衰竭）进行校正后，医院获得性菌血症显著影响重症监护病房患者的结局（比值比：3.4；95%CI：1.3-8.7；P=0.010）。这项研究表明，住院患者中，通气患者和中性粒细胞减少患者的医院获得性菌血症结局较差，且医院获得性菌血症本身会影响重症监护病房患者的结局。
