Department of Infectious Diseases, Aalborg Hospital, Aarhus University Hospital, Denmark.
APMIS. 2011 Apr;119(4-5):275-9. doi: 10.1111/j.1600-0463.2011.02727.x. Epub 2011 Mar 22.
An unknown focus of infection is associated with an increased risk of death in patients with bacteraemia. However, the implications for patient management remain uncertain, and to our knowledge, the validity of an unknown focus has not been evaluated. Therefore, we conducted a retrospective record review of bacteraemias with an unknown focus recorded in a regional bacteraemia database. The study cohort comprised 645 cases of bacteraemia diagnosed in 537 hospitalized patients at Aalborg Hospital, Denmark, in 2003. The focus was unknown in 184 (29%) bacteraemia episodes (162 patients). The record review pointed conclusively to a focus in 39 episodes. The positive predictive value of an unknown focus was 79% and the proportion of bacteraemias with a focus increased from 71% to 78%. Among the 145 cases of bacteraemia with a de facto unknown focus, there were 36 incidents of febrile neutropenia and 20 additional incidents of early death which precluded a search for a focus. The study confirmed the focus to be de facto absent in most patients classified with an unknown focus. The distribution of foci changed only marginally by the disclosure of a focus in one of five patients in the 'unknown' group.
感染灶不明与菌血症患者的死亡风险增加相关。然而，这对患者管理的影响仍不确定，据我们所知，未知感染灶的有效性尚未得到评估。因此，我们对丹麦奥尔堡医院的一个区域性菌血症数据库中记录的不明感染灶的菌血症进行了回顾性病历审查。该研究队列包括 2003 年在丹麦奥尔堡医院住院的 537 名患者中诊断出的 645 例菌血症。184 例（29%）菌血症发作（162 名患者）感染灶不明。病历审查明确指向 39 例菌血症。未知感染灶的阳性预测值为 79%，且有感染灶的菌血症比例从 71%增加至 78%。在 145 例事实上无明确感染灶的菌血症中，有 36 例发热性中性粒细胞减少症和 20 例早期死亡的额外事件，这些事件排除了对感染灶的寻找。该研究证实，在大多数被归类为感染灶不明的患者中，感染灶实际上不存在。通过在“不明”组中的五分之一患者中发现一个感染灶，感染灶的分布仅略有变化。
