[大学医院中多重微生物菌血症-真菌血症患者死亡率的预后及危险因素比较研究：10年发展情况]

Ruiz-Giardín José Manuel, Noguerado A, Pizarro A, Méndez J, La Hulla F, Fernández M, Hernández F, San Martín J V, Hernández I, Alvarez J, Salvanes F

Servicio de Medicina Interna-Infecciosas. Hospital Universitario de La Princesa. Madrid. España.

Enferm Infecc Microbiol Clin. 2002 Nov;20(9):435-42.

OBJECTIVE

Eighty-two episodes of polymicrobial bacteremia in two time periods, 1986-87 and 1996-97, were compared to assess differences in risk factors and outcome to mortality.

METHODS

A prospective, concurrent, anterograde study with univariate analysis of all episodes of polymicrobial bacteremia was performed in Hospital de la Princesa. Logistic regression analysis was applied to all significant variables (p < 0.05) in the univariate analysis in either of the two time periods.

RESULTS

Variables showing statistically significant differences in incidence between the two time periods included the following: hospital acquired bacteremia; previous use of antibiotics; genitourinary, respiratory and cardiovascular manipulations; septic metastases; and absence of leukocytosis. These factors were more frequently present during 1986-87 than during 1996-97. The overall RR of outcome to mortality was five-fold greater during the first period than the second: RR 5.6 (CI 1.76-17.56) p < 0.001. The clinical characteristics at the onset of bacteremia associated with mortality in the first period were: underlying disease - < RR 2.20 (CI 1.18-4.08), steroid treatment - < RR 4.24 (CI 0.68-26.59), hypotension - < RR 2.05 (CI 1.0-4.17), and disseminated intravascular coagulation - < RR 2.31 (CI 1.69-3.35). Clinical characteristics at the onset of bacteremia associated with mortality in the second period were: hypotension - < RR 1.44 (CI 1.01-2.08), underlying disease - < RR 1.16 (CI 1.02-1.34), and disseminated intravascular coagulation - < RR 6.40 (CI 1.15-35.69). The variables independently associated with mortality in polymicrobial bacteremia were: period - < RR 2.05 (CI 1.50-2.10), underlying disease - < RR 7.05 (CI 2.68-7.50), hypotension - < RR 7.06 (CI 3.80-7.29), and (probably) vascular manipulations - < RR 3.41 (CI 0.85-4.53).

CONCLUSION

Polymicrobial bacteremia-associated mortality was five-fold greater in 1986-87 than in 1996-97. The variables independently associated with mortality risk were underlying disease, hypotension, the period studied (which would include a number of variables not analyzed in this work) and, probably, vascular manipulations.

目的

比较1986 - 1987年和1996 - 1997年两个时间段内的82例多微生物菌血症病例，以评估危险因素及死亡结局的差异。

方法

在公主医院进行了一项前瞻性、同期、顺行性研究，对所有多微生物菌血症病例进行单因素分析。对两个时间段中任一时间段单因素分析中所有显著变量（p < 0.05）应用逻辑回归分析。

结果

两个时间段发病率显示出统计学显著差异的变量包括：医院获得性菌血症；先前使用抗生素；泌尿生殖系统、呼吸系统和心血管系统操作；脓毒性转移；以及无白细胞增多。这些因素在1986 - 1987年比1996 - 1997年更频繁出现。第一个时间段死亡结局的总体相对风险比第二个时间段高五倍：相对风险比5.6（可信区间1.76 - 17.56），p < 0.001。第一个时间段菌血症发作时与死亡相关的临床特征为：基础疾病 - <相对风险比2.20（可信区间1.18 - 4.08），类固醇治疗 - <相对风险比4.24（可信区间0.68 - 26.59），低血压 - <相对风险比2.05（可信区间1.0 - 4.17），以及弥散性血管内凝血 - <相对风险比2.31（可信区间1.69 - 3.35）。第二个时间段菌血症发作时与死亡相关的临床特征为：低血压 - <相对风险比1.44（可信区间1.01 - 2.08），基础疾病 - <相对风险比1.16（可信区间1.02 - 1.34），以及弥散性血管内凝血 - <相对风险比6.40（可信区间1.15 - 35.69）。多微生物菌血症中与死亡独立相关的变量为：时间段 - <相对风险比2.05（可信区间1.50 - 2.10），基础疾病 - <相对风险比7.05（可信区间2.68 - 7.50），低血压 - <相对风险比7.06（可信区间3.80 - 7.29），以及（可能）血管操作 - <相对风险比3.41（可信区间0.85 - 4.53）。