血流培养阳性时间与大肠埃希菌菌血症患者临床特征及住院死亡率的关系。

Relationship between time to positivity of blood culture with clinical characteristics and hospital mortality in patients with Escherichia coli bacteremia.

机构信息

Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100083, China.

出版信息

Chin Med J (Engl). 2011 Feb;124(3):330-4.

Abstract

BACKGROUND

Previous studies indicated that the time to positivity (TTP) of blood culture is a parameter correlating with degree of the bacteremia and outcome in patients with bloodstream infections caused by Escherichia coli (E. coli). The objective of this study was to further investigate the diagnostic and prognostic power of using TTP to predict E. coli bacteremia.

METHODS

A retrospective cohort study at two university hospitals was conducted. We retrieved all the medical records of those with E. coli bloodstream infection according to the records generated by their microbiology departments. Univariate and multivariate analyses were applied to identify clinical factors correlating with fast bacterial growth and significant prognostic factors for hospital mortality.

RESULTS

Medical records of 353 episodes of E. coli bacteremia diagnosed between January 1, 2007 and December 31, 2009 were retrieved in the investigation. Univariate analysis demonstrated that the TTP ≤ 7 hours group is associated with higher incidence of active malignancies (41.7% vs. 27.2%, P = 0.010), neutropenia (30% vs.14.3%, P = 0.007), primary bacteremia (55.0% vs. 33.4%, P = 0.002), and poorer outcome (hospital mortality 43.3% vs.11.9%, P = 0.000) than the TTP > 7 hours group. Multivariate analysis revealed that the significant predictors of hospital mortality, in rank order from high to low, were TTP (for TTP ≤ 7 hours, odds ratio (OR): 4.886; 95% confidence interval (CI): 2.572 - 9.283; P = 0.000), neutropenia (OR: 2.800; 95%CI: 1.428 - 5.490; P = 0.003), comedication of steroids or immunosuppressive agents (OR: 2.670; 95%CI: 0.971 - 7.342; P = 0.057).

CONCLUSIONS

Incidence of malignancies, neutropenia and primary bacteremia correlates with fast bacterial growth in patients with E. coli bacteremia. The parameter of TTP has been identified as a variable of highest correlation to hospital mortality and therefore can be potentially utilized as a mortality prognostic marker.

摘要

背景

先前的研究表明血培养阳性时间（TTP）是与大肠埃希菌（E. coli）引起的血流感染患者菌血症程度和结局相关的参数。本研究的目的是进一步探讨使用 TTP 预测大肠埃希菌菌血症的诊断和预后能力。

方法

对两家大学医院进行回顾性队列研究。根据微生物科的记录，我们检索了所有大肠埃希菌血流感染患者的病历。应用单因素和多因素分析来确定与快速细菌生长相关的临床因素和医院死亡率的显著预后因素。

结果

在调查中，检索到了 2007 年 1 月 1 日至 2009 年 12 月 31 日期间诊断的 353 例大肠埃希菌菌血症发作的病历。单因素分析表明，TTP≤7 小时组与更高的活动性恶性肿瘤发生率（41.7%比 27.2%，P=0.010）、中性粒细胞减少症（30%比 14.3%，P=0.007）、原发性菌血症（55.0%比 33.4%，P=0.002）和更差的预后（医院死亡率 43.3%比 11.9%，P=0.000）相关。多因素分析显示，医院死亡率的显著预测因素按降序排列依次为 TTP（对于 TTP≤7 小时，优势比（OR）：4.886；95%置信区间（CI）：2.572-9.283；P=0.000）、中性粒细胞减少症（OR：2.800；95%CI：1.428-5.490；P=0.003）、同时使用类固醇或免疫抑制剂（OR：2.670；95%CI：0.971-7.342；P=0.057）。