Velasco E, Soares M, Byington R, Martins C A S, Schirmer M, Dias L M C, Gonçalves V M S
Rua General Glicério 486/1002, 22245-120 Rio de Janeiro, Brazil.
Eur J Clin Microbiol Infect Dis. 2004 Aug;23(8):596-602. doi: 10.1007/s10096-004-1181-x. Epub 2004 Jul 28.
The aim of this study was to describe the epidemiology and microbiology of bloodstream infections (BSIs) among adult surgical cancer patients and to determine independent factors that influence in-hospital mortality. The study enrolled 112 consecutive episodes of BSIs in adult surgical cancer patients during a 26-month period. The median age of the patients was 64.5 years, and crude in-hospital mortality was 19.6%. The median time from surgery to the index blood culture was 11 days and from index blood culture to death was 4.5 days. Seventy-five percent of the patients had an advanced tumor disease, 36.6% were under intensive care, and 68.7% had a central venous catheter in place at the time the bloodstream infection was diagnosed. Associated infected sites were present in 57.1% of the episodes. There were 328 noninfectious co-morbid conditions. Poor performance status, weight loss, hypoalbuminemia, and ventilatory support accounted for 67.4% of them. There was a predominance of aerobic gram-negative bacilli (62%), followed by gram-positive cocci (26.6%) and fungi (9.3%). The observed mortality rates associated with these organism groups were similar (23.6% vs 15% vs 28.6%, respectively; P=0.44). The most frequent organisms were Enterobacter spp., coagulase-negative staphylococci, Klebsiella spp., Acinetobacter spp., and fungi. Nonfermentative strains predominated in patients with catheters. Thirty-five (30.2%) pathogens were considered resistant. There was no significant difference in the mortality rate between patients with resistant and those with nonresistant organisms (20% vs 26%, respectively; P=0.49). Logistic regression analysis showed > or = 4 co-morbid conditions, advanced tumor, thoracic surgery, catheter retention, and pulmonary infiltrates as independent predictors of mortality. Medical and infection control measures addressing certain variables amenable to intervention might reduce the negative impact of postoperative infectious morbidity and mortality of BSIs in adult surgical cancer patients.
本研究的目的是描述成年外科癌症患者血流感染（BSIs）的流行病学和微生物学特征，并确定影响住院死亡率的独立因素。该研究纳入了26个月期间成年外科癌症患者连续发生的112例血流感染病例。患者的中位年龄为64.5岁，粗住院死亡率为19.6%。从手术到首次血培养的中位时间为11天，从首次血培养到死亡的中位时间为4.5天。75%的患者患有晚期肿瘤疾病，36.6%的患者接受重症监护，68.7%的患者在诊断血流感染时已留置中心静脉导管。57.1%的病例存在相关感染部位。共有328种非感染性合并症。功能状态差、体重减轻、低白蛋白血症和通气支持占其中的67.4%。需氧革兰氏阴性杆菌占主导（62%），其次是革兰氏阳性球菌（26.6%）和真菌（9.3%）。与这些微生物组相关的观察到的死亡率相似（分别为23.6%、15%和28.6%；P = 0.44）。最常见的微生物是肠杆菌属、凝固酶阴性葡萄球菌、克雷伯菌属、不动杆菌属和真菌。非发酵菌株在有导管的患者中占主导。35种（30.2%）病原体被认为具有耐药性。耐药菌患者和非耐药菌患者的死亡率无显著差异（分别为20%和26%；P = 0.49）。逻辑回归分析显示，≥4种合并症、晚期肿瘤、胸外科手术、导管留置和肺部浸润是死亡率的独立预测因素。针对某些可干预变量的医疗和感染控制措施可能会降低成年外科癌症患者术后感染性发病和血流感染死亡率的负面影响。
