Marra Alexandre R, Bar Katharine, Bearman Gonzalo M L, Wenzel Richard P, Edmond Michael B
Division of Infectious Diseases, Brazil (UNIFESP-EPM)/Hospital São Paulo (HSP), Universidade Federal de São Paulo, São Paulo, Brazil.
J Infect. 2006 Jul;53(1):30-5. doi: 10.1016/j.jinf.2005.08.032. Epub 2005 Oct 25.
To evaluate relationships between the inflammatory response, clinical course, and outcome of nosocomial BSI due to Pseudomonas aeruginosa.
We performed a historical cohort study on 77 adults with P. aeruginosa (Pa) nBSI to define the associated systemic inflammatory response syndrome (SIRS). We examined SIRS scores 2 days prior through 14 days after the first positive blood culture. Imipenem resistant--IRPa (n=20) and susceptible infections--ISPa (n=57) were compared. Variables significant in univariate analysis were entered into a logistic regression model.
Seventy-four percent of BSI were ISPa and 26.0% by IRPa. Septic shock occurred in 39.0%. Crude mortality was 48.1%. There was no difference in APACHE II (AP2) scores on days -2, -1 and 0 between the ISPa and IRPa groups. Multivariate analysis revealed that AP2> or =20 at BSI onset (P<0.001) and hematologic failure (P=0.001) independently predicted death.
In patients with P. aeruginosa nBSI, the incidence of septic shock and organ failure is high; patients with IRPa BSI are not more acutely ill prior to infection than those with ISPa BSI and outcome is not significantly different; AP2> or =20 at BSI onset and the development of hematologic failure are independent predictors of death.
评估铜绿假单胞菌所致医院获得性血流感染（BSI）的炎症反应、临床病程及预后之间的关系。
我们对77例成年铜绿假单胞菌（Pa）医院获得性血流感染患者进行了一项历史性队列研究，以确定相关的全身炎症反应综合征（SIRS）。我们检查了首次血培养阳性前2天至后14天的SIRS评分。比较了耐亚胺培南铜绿假单胞菌（IRPa，n = 20）感染和敏感感染（ISPa，n = 57）。将单因素分析中有意义的变量纳入逻辑回归模型。
74%的血流感染为ISPa，26.0%为IRPa。39.0%发生感染性休克。粗死亡率为48.1%。ISPa组和IRPa组在第-2、-1和0天的急性生理与慢性健康状况评分系统II（APACHE II，AP2）评分无差异。多因素分析显示，血流感染发作时AP2≥20（P<0.001）和血液学衰竭（P = 0.001）可独立预测死亡。
在铜绿假单胞菌医院获得性血流感染患者中，感染性休克和器官衰竭的发生率很高；耐亚胺培南铜绿假单胞菌血流感染患者在感染前并不比敏感感染患者病情更急，预后无显著差异；血流感染发作时AP2≥20和血液学衰竭的发生是死亡的独立预测因素。
