空肠弯曲菌血症：临床特征及与致命结局相关的因素

Campylobacter bacteremia: clinical features and factors associated with fatal outcome.

作者信息

Pacanowski Jérôme, Lalande Valérie, Lacombe Karine, Boudraa Cherif, Lesprit Philippe, Legrand Patrick, Trystram David, Kassis Najiby, Arlet Guillaume, Mainardi Jean-Luc, Doucet-Populaire Florence, Girard Pierre-Marie, Meynard Jean-Luc

机构信息

Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France.

出版信息

Clin Infect Dis. 2008 Sep 15;47(6):790-6. doi: 10.1086/591530.

DOI:10.1086/591530

PMID:18699745

Abstract

BACKGROUND

Campylobacter bacteremia is uncommon. The influence of underlying conditions and of the impact of antibiotics on infection outcome are not known.

METHODS

From January 2000 through December 2004, 183 episodes of Campylobacter bacteremia were identified in 23 hospitals in the Paris, France, area. The medical records were reviewed. Characteristics of bacteremia due to Campylobacter fetus and to other Campylobacter species were compared. Logistic regression analysis was performed to identify risk factors for fatal outcome within 30 days.

RESULTS

Most affected patients were elderly or immunocompromised. C. fetus was the most commonly identified species (in 53% of patients). The main underlying conditions were liver disease (39%) and cancer (38%). The main clinical manifestations were diarrhea (33%) and skin infection (16%). Twenty-seven patients (15%) died within 30 days. Compared with patients with bacteremia due to other Campylobacter species, patients with C. fetus bacteremia were older (mean age, 69.5 years vs. 55.6 years; P = .001) and were more likely to have cellulitis (19% vs. 7%; P = .03), endovascular infection (13% vs. 1%; P = .007), or infection associated with a medical device (7% vs. 0%; P = .02). Independent risk factors for death were cancer (odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2-20.8) and asymptomatic infection (OR, 6.7; 95% CI, 1.5-29.4) for C. fetus bacteremia, the absence of prescription of appropriate antibiotics (OR, 12.2; 95% CI, 0.9-157.5), and prescription of third-generation cephalosporins (OR, 10.2; 95% CI, 1.9-53.7) for bacteremia caused by other species.

CONCLUSIONS

Campylobacter bacteremia occurs mainly in immunocompromised patients. Clinical features and risk factors of death differ by infection species.

摘要

背景

弯曲杆菌血症并不常见。潜在疾病以及抗生素对感染结局的影响尚不清楚。

方法

2000年1月至2004年12月期间，在法国巴黎地区的23家医院中确定了183例弯曲杆菌血症病例。对病历进行了回顾。比较了胎儿弯曲杆菌和其他弯曲杆菌属引起的菌血症的特征。进行逻辑回归分析以确定30天内死亡结局的危险因素。

结果

大多数受影响的患者为老年人或免疫功能低下者。胎儿弯曲杆菌是最常鉴定出的菌种（占患者的53%）。主要的潜在疾病是肝病（39%）和癌症（38%）。主要临床表现为腹泻（33%）和皮肤感染（16%）。27例患者（15%）在30天内死亡。与其他弯曲杆菌属引起菌血症的患者相比，胎儿弯曲杆菌菌血症患者年龄更大（平均年龄69.5岁对55.6岁；P = 0.001），更易发生蜂窝织炎（19%对7%；P = 0.03）、血管内感染（13%对1%；P = 0.007）或与医疗器械相关的感染（7%对0%；P = 0.02）。胎儿弯曲杆菌菌血症死亡的独立危险因素是癌症（比值比[OR]，5.1；95%置信区间[CI]，1.2 - 20.8）和无症状感染（OR，6.7；95% CI，1.5 - 29.4），其他菌种引起菌血症死亡的独立危险因素是未使用适当抗生素（OR，12.2；95% CI，0.9 - 157.5）以及使用第三代头孢菌素（OR，10.2；95% CI，1.9 - 53.7）。