Cooper University Hospital, Camden, New Jersey, USA.
Vox Sang. 2009 Nov;97(4):294-302. doi: 10.1111/j.1423-0410.2009.01134.x. Epub 2009 Aug 4.
Packed red blood cell transfusion has been associated with increased infection in a variety of critically ill patient populations. We evaluated the microbiology and time course of infection in transfused patients in the intensive care unit (ICU) as no data exist on these parameters.
We performed a retrospective review of data for all patients admitted to a 24-bed medical-surgical ICU at Cooper University Hospital from July 2003 to September 2006 and entered in the Project Impact database.
A total of 2432 patients were admitted during the study period, of which 609 underwent transfusion. Transfused patients were more likely to develop a nosocomial infection (10.5% vs. 4.9%, P < 0.001). ICU and hospital length of stay were longer in the transfused group (P < 0.001 for both). Mortality was also greater (13.1% vs. 8.7%, P = 0.001). Transfused patients had a shorter time from hospital admission to first infection (P < 0.001) and ICU admission to first infection (P < 0.001). Multivariate analysis confirmed transfusion as an independent risk factor for infection, mortality, hospital and ICU length of stay. Methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus and Acinetobacter occurred more often in transfused patients. Acinetobacter accounted for a disproportionate share of infections among transfused patients (P < 0.001).
Transfused ICU patients have a higher incidence of nosocomial infection and worse outcomes. Transfused patients had a shorter onset of infection. Acinetobacter infection appears to be particularly common among these patients. Further investigation is merited to better elucidate the mechanism for these findings and their therapeutic and clinical implications.
在各种危重症患者群体中，输注红细胞悬液与感染增加相关。我们评估了 ICU 中接受输血的患者的微生物学和感染时间进程，因为在此类参数方面尚无数据。
我们对 2003 年 7 月至 2006 年 9 月期间在库珀大学医院 24 张病床的内科-外科 ICU 收治并输入 Project Impact 数据库的所有患者的数据进行了回顾性分析。
在研究期间，共有 2432 名患者入院，其中 609 名患者接受了输血。输血患者发生医院获得性感染的可能性更高（10.5% vs. 4.9%，P < 0.001）。输血组 ICU 和住院时间也更长（均 P < 0.001）。死亡率也更高（13.1% vs. 8.7%，P = 0.001）。从住院到首次感染（P < 0.001）以及从 ICU 入院到首次感染（P < 0.001），输血患者的时间更短。多变量分析证实输血是感染、死亡率、住院时间和 ICU 住院时间的独立危险因素。耐甲氧西林金黄色葡萄球菌、万古霉素耐药肠球菌和不动杆菌在输血患者中更为常见。在输血患者中，不动杆菌感染占比不成比例（P < 0.001）。
接受输血的 ICU 患者发生医院获得性感染和不良结局的风险更高。输血患者感染的潜伏期更短。不动杆菌感染似乎在这些患者中特别常见。需要进一步研究以更好地阐明这些发现的机制及其治疗和临床意义。
