Fernández-Rufete A, García-Vázquez E, Hernández-Torres A, Canteras M, Ruiz J, Gómez J
Servicio de MI-Infecciosas, Hospital Universitario Virgen de la Arrixaca, El Palmar (Murcia), Spain.
Rev Esp Quimioter. 2012 Sep;25(3):199-205.
Coagulase-negative staphylococci (CNS) are the most frequent isolated microorganism in blood cultures; mortality has been associated to severity and to adequacy of empirical treatment but the relevance of the latter is not clearly recognised. The aims of the study were to analyze clinical and microbiological factors related to mortality in patients with CNS bacteraemia and the influence of empirical treatment in prognosis.
A prospective cohort study of patients with CNS bacteraemia was performed (January to June 2010) at a university-affiliated hospital; a determination of clinical significance was made and true bacteraemia was defined according to CDC criteria. We analysed epidemiological, clinical and microbiological variables related to mortality.
A total of 269 cases were included (97 were considered true bacteraemia); 92% survived and mortality was 8% (1.6% CNS bacteraemia related mortality). Staphylococcus epidermidis was the most frequent isolated species; 93 patients were included in the related mortality study of patients with true bacteraemia. Factors associated to mortality in the bivariate analysis (p<0.05) were: Winton score I-III, presence of pacemakers, sepsis or infective endocarditis and persistent bacteraemia. Adequate empirical treatment was not associated to survival.
Severity at onset, the development of septic complications and having a pacemaker are associated to mortality in patients with CNS bacteraemia; in our cohort, inadequate empirical treatment is not related to mortality.
凝固酶阴性葡萄球菌（CNS）是血培养中最常分离出的微生物；死亡率与病情严重程度及经验性治疗的充分性有关，但后者的相关性尚未得到明确认识。本研究的目的是分析与CNS菌血症患者死亡率相关的临床和微生物学因素，以及经验性治疗对预后的影响。
在一所大学附属医院对CNS菌血症患者进行了一项前瞻性队列研究（2010年1月至6月）；确定了临床意义，并根据美国疾病控制与预防中心（CDC）标准定义了真性菌血症。我们分析了与死亡率相关的流行病学、临床和微生物学变量。
共纳入269例病例（97例被认为是真性菌血症）；92%存活，死亡率为8%（1.6%为CNS菌血症相关死亡率）。表皮葡萄球菌是最常分离出的菌种；93例患者纳入了真性菌血症患者的相关死亡率研究。双变量分析中与死亡率相关的因素（p<0.05）为：温顿评分I-III、存在起搏器、脓毒症或感染性心内膜炎以及持续性菌血症。充分的经验性治疗与生存无关。
发病时的严重程度、脓毒症并发症的发生以及有起搏器与CNS菌血症患者的死亡率相关；在我们的队列中，经验性治疗不充分与死亡率无关。
