Duke University Medical Center, Durham, NC, USA.
Am J Med. 2010 Sep;123(9):819-28. doi: 10.1016/j.amjmed.2010.03.021.
Bloodstream infections are a major cause of morbidity and mortality in adults. Bloodstream infections should be reassessed periodically because of increased antibiotic resistance, more patients receiving immunomodulatory therapy, improved antiretroviral therapy, and acquisition of infection in health care settings other than hospitals.
We conducted retrospective assessment by infectious disease physicians of hospitalized adults with positive blood cultures at 3 academic medical centers.
Two thousand two hundred seventy positive blood culture episodes occurred in 1706 patients. Of 2669 isolates, 51% represented true infection, 41% contamination, and 8% unknown clinical significance. Although coagulase-negative staphylococci were most common, only 10% were clinically significant. Among 1225 true bloodstream infections, the most frequent isolates were Staphylococcus aureus, Escherichia coli, Enterococcus spp., Klebsiella pneumoniae, coagulase-negative staphylococci, Pseudomonas aeruginosa, Candida albicans, Enterobacter cloacae, and Serratia marcescens. Intravenous catheters were the most common primary source of bloodstream infection (23% of episodes). Most (81%) bloodstream infections were acquired in the hospital or other health care settings. Crude and attributable in-hospital case-fatality ratios were 20% and 12%, respectively, lower than in previous studies. Increasing age, hypotension, absence of fever, hospital acquisition, extreme white blood cell count values, and the presence of the acquired immunodeficiency syndrome, malignancy, or renal disease were significantly associated with an increased risk of in-hospital attributable death in multivariable analysis.
The proportion of bloodstream infections due to intravenous catheters is continuing to increase. Most episodes were acquired in the hospital or other health care setting. In-hospital case-fatality ratios have decreased compared with previous studies. Several previously identified factors associated with an increased mortality remain statistically significant.
血流感染是成年人发病率和死亡率的主要原因。由于抗生素耐药性增加、更多患者接受免疫调节治疗、抗逆转录病毒治疗改善以及在医院以外的医疗保健环境中获得感染，应定期重新评估血流感染。
我们在 3 所学术医疗中心对患有血流感染的住院成人患者进行了传染病医生的回顾性评估。
1706 例患者发生了 2270 例阳性血培养。在 2669 株分离株中，51%代表真正的感染，41%为污染，8%为临床意义不明。虽然凝固酶阴性葡萄球菌最为常见，但只有 10%具有临床意义。在 1225 例真正的血流感染中，最常见的分离株为金黄色葡萄球菌、大肠杆菌、肠球菌属、肺炎克雷伯菌、凝固酶阴性葡萄球菌、铜绿假单胞菌、白色念珠菌、阴沟肠杆菌和粘质沙雷菌。静脉导管是血流感染最常见的主要来源（占感染事件的 23%）。大多数（81%）血流感染是在医院或其他医疗保健环境中获得的。粗病死率和归因于医院的病死率分别为 20%和 12%，低于以往的研究。多变量分析显示，年龄增长、低血压、无发热、医院获得性感染、白细胞计数极高值以及获得性免疫缺陷综合征、恶性肿瘤或肾脏疾病的存在与归因于医院的死亡风险增加显著相关。
由静脉导管引起的血流感染比例持续增加。大多数感染事件发生在医院或其他医疗保健环境中。与以往的研究相比，院内病死率有所下降。几个以前确定的与死亡率增加相关的因素在统计学上仍然显著。
