Department of Emergency Medicine, E-Da Hospital/I-Shou University, Kaohsiung County, Taipei, Taiwan.
Acad Emerg Med. 2010 Oct;17(10):1072-9. doi: 10.1111/j.1553-2712.2010.00871.x.
Polymicrobial bloodstream infection (BSI) is a critical condition and has been increasingly reported; however, the authors were unable to find an emergency department (ED) patient-based study in the literature.
A retrospective matched case-control study with a ratio of 1:3 among patients with polymicrobial BSIs in an ED was conducted. The case group was patients aged > 16 years with polymicrobial BSIs. Patients matched for age and sex with monomicrobial BSIs were sampled as the control group. Demographic information, underlying conditions, microbiologic data, and outcomes were collected for further analysis.
From January 2005 to December 2007, a total of 112 episodes of polymicrobial BSIs among 109 patients were included. Two pathogens were isolated among 87 (77.7%) episodes and three were found among 25 (22.3%) episodes. A history of hospitalization within 90 days was an independent risk factor for polymicrobial BSIs (p = 0.003). Intraabdominal infection (p < 0.001) and respiratory tract infection (p = 0.017) were more likely to be associated with polymicrobial BSIs. Gram-negative and Gram-positive bacteria were documented in 95.5 and 46.4% episodes of polymicrobial BSIs, respectively. Inappropriate antimicrobial treatment was observed in 53.6% of polymicrobial BSIs, but only accounted for 23.8% of monomicrobial BSIs (p < 0.001). The overall 30-day mortality rate of the polymicrobial group was significantly higher than those with monomicrobial BSIs (30.3 and 11.6%, respectively; p < 0.001).
Patients with polymicrobial BSIs had a high mortality rate. Acknowledgment of the clinical and microbiologic characteristics and recognition of patients at risk for polymicrobial BSIs are critical in EDs.
多微生物血流感染（BSI）是一种危急病症，越来越多的文献对此进行了报道；然而，作者在文献中无法找到基于急诊科（ED）患者的研究。
进行了一项回顾性配比病例对照研究，ED 中多微生物 BSI 患者的病例组与对照组的比例为 1:3。病例组为年龄>16 岁的多微生物 BSI 患者。将年龄和性别与单微生物 BSI 相匹配的患者作为对照组进行采样。收集人口统计学信息、基础疾病、微生物学数据和结局进行进一步分析。
2005 年 1 月至 2007 年 12 月，共纳入 109 例患者的 112 例多微生物 BSI 发作。87 例（77.7%）发作中分离出两种病原体，25 例（22.3%）发作中分离出三种病原体。90 天内住院史是多微生物 BSI 的独立危险因素（p = 0.003）。腹腔内感染（p < 0.001）和呼吸道感染（p = 0.017）更可能与多微生物 BSI 相关。多微生物 BSI 中分别有 95.5%和 46.4%的发作记录了革兰氏阴性和革兰氏阳性细菌。53.6%的多微生物 BSI 存在不适当的抗菌治疗，但仅占单微生物 BSI 的 23.8%（p < 0.001）。多微生物组的 30 天总死亡率明显高于单微生物 BSI 组（分别为 30.3%和 11.6%；p < 0.001）。
多微生物 BSI 患者的死亡率较高。在急诊科，承认多微生物 BSI 的临床和微生物学特征并识别出存在多微生物 BSI 风险的患者至关重要。
