Lizaso Diego, Aguilera C Karina, Correa Malena, Yantorno María Laura, Cuitiño Mario, Pérez Lorena, Lares Mónica, Parra Gloria de la, Esposto Amadeo
Servicio de Infectología, Hospital Interzonal de Agudos San Martín, Buenos Aires, Argentina.
Rev Chilena Infectol. 2008 Oct;25(5):368-73. Epub 2008 Oct 1.
Nosocomial bacteremia is a major cause of hospital infection, associated with high rate of morbidity and mortality, prolonged hospital stay and higher costs. However, few prospective studies analyse the prognostic factors associated with mortality of gramnegative rods bloodstream infections in hospital wards outside of intensive care units. A prospective/descriptive study was conducted from March to December 2006. All patients with nosocomial-acquired bloodstream infection due to gramnegative rods were included. Epidemiology and clinical features were analysed as potential prognostic factors for mortality. During the study period, 84 cases were detected, being A. baumannii, Burkholderia sp and E. coli the most frequent isolates, with a mortality of 48%>. Bacteremia derived from a high-mortality associated septic focus (RR 4.9, IC95%> 1.3 - 18.8) and admission to intensive care unit (RR 4.78, IC95%> 1.7- 13.1) were independent variables associated with mortality. Inappropriate empirical antibiotic treatment was not associated with greater risk of mortality. Nosocomial gramnegative bloodstream infections in our series were mainly due to non-fermentative bacilli and were associated with high mortality rates when their origin was a high risk septic focus or the patient was admitted to intensive care unit.
医院获得性菌血症是医院感染的主要原因，与高发病率、高死亡率、住院时间延长及更高的费用相关。然而，很少有前瞻性研究分析重症监护病房以外的医院病房中革兰氏阴性杆菌血流感染死亡率的相关预后因素。于2006年3月至12月开展了一项前瞻性/描述性研究。纳入所有因革兰氏阴性杆菌导致医院获得性血流感染的患者。对流行病学和临床特征进行分析，作为死亡率的潜在预后因素。在研究期间，共检测到84例病例，鲍曼不动杆菌、伯克霍尔德菌属和大肠杆菌是最常见的分离菌株，死亡率为48%。源自高死亡率相关脓毒症病灶的菌血症（相对危险度4.9，95%置信区间1.3 - 18.8）和入住重症监护病房（相对危险度4.78，95%置信区间1.7 - 13.1）是与死亡率相关的独立变量。经验性抗生素治疗不当与更高的死亡风险无关。我们系列研究中的医院获得性革兰氏阴性血流感染主要由非发酵菌引起，当感染源为高风险脓毒症病灶或患者入住重症监护病房时，死亡率较高。
