Hoste Eric A J, Blot Stijn I, Lameire Norbert H, Vanholder Raymond C, De Bacquer Dirk, Colardyn Francis A
Intensive Care Unit, Department of Public Health, Ghent University Hospital, Gent, Belgium.
J Am Soc Nephrol. 2004 Feb;15(2):454-62. doi: 10.1097/01.asn.0000110182.14608.0c.
Critically ill patients with acute renal failure (ARF) treated with renal replacement therapy (RRT) have a high mortality. The authors evaluated a cohort of 704 consecutive intensive care unit (ICU) patients with ARF treated with RRT to determine whether there was an increased incidence of nosocomial bloodstream infection and whether this resulted in a worse outcome. The incidence of nosocomial bloodstream infection was 8.8%, higher than that reported in other series of general ICU patients and also higher than the 3.5% incidence of bloodstream infection in non-ARF patients in the same unit (P < 0.001). There were more bloodstream infections caused by Gram-positive species compared with Gram-negative species or fungi. The distribution over the species was comparable to that reported by others for a general ICU population. The outcome was evaluated with matched cohort analysis. With this technique, patients with bloodstream infection (exposed) were closely matched with patients without bloodstream infection (non-exposed) in a 1:2 ratio. Matching was based on the APACHE II system and length of stay before bloodstream infection (exposure time). Length of stay and mortality were equal in exposed and non-exposed patients. There was also no difference in hospital costs. It can be concluded that critically ill patients with ARF treated with RRT were more susceptible to nosocomial bloodstream infection. Nevertheless, the outcome was not influenced by the presence of bloodstream infection. The high mortality observed in ARF patients could therefore not be attributed to the higher incidence of bloodstream infection.
接受肾脏替代治疗（RRT）的急性肾衰竭（ARF）重症患者死亡率很高。作者评估了一组连续704例接受RRT治疗的重症监护病房（ICU）ARF患者，以确定医院血流感染的发生率是否增加，以及这是否会导致更差的预后。医院血流感染的发生率为8.8%，高于其他系列普通ICU患者的报告发生率，也高于同一科室非ARF患者3.5%的血流感染发生率（P<0.001）。与革兰氏阴性菌或真菌相比，革兰氏阳性菌引起的血流感染更多。物种分布与其他报告的普通ICU人群的分布相当。采用匹配队列分析评估预后。通过这种技术，血流感染患者（暴露组）与无血流感染患者（非暴露组）以1:2的比例进行密切匹配。匹配基于急性生理与慢性健康状况评分系统II（APACHE II）和血流感染前的住院时间（暴露时间）。暴露组和非暴露组患者的住院时间和死亡率相同。住院费用也没有差异。可以得出结论，接受RRT治疗的ARF重症患者更容易发生医院血流感染。然而，预后不受血流感染的影响。因此，ARF患者中观察到的高死亡率不能归因于血流感染发生率的增加。
