重新评估医疗保健相关和社区获得性菌血症的结局：一项前瞻性队列研究。
Reappraisal of the outcome of healthcare-associated and community-acquired bacteramia: a prospective cohort study.
机构信息
Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Seville, Spain.
出版信息
BMC Infect Dis. 2013 Jul 24;13:344. doi: 10.1186/1471-2334-13-344.
BACKGROUND
Healthcare-associated (HCA) bloodstream infections (BSI) have been associated with worse outcomes, in terms of higher frequencies of antibiotic-resistant microorganisms and inappropriate therapy than strict community-acquired (CA) BSI. Recent changes in the epidemiology of community (CO)-BSI and treatment protocols may have modified this association. The objective of this study was to analyse the etiology, therapy and outcomes for CA and HCA BSI in our area.
METHODS
A prospective multicentre cohort including all CO-BSI episodes in adult patients was performed over a 3-month period in 2006-2007. Outcome variables were mortality and inappropriate empirical therapy. Adjusted analyses were performed by logistic regression.
RESULTS
341 episodes of CO-BSI were included in the study. Acquisition was HCA in 56% (192 episodes) of them. Inappropriate empirical therapy was administered in 16.7% (57 episodes). All-cause mortality was 16.4% (56 patients) at day 14 and 20% (71 patients) at day 30. After controlling for age, Charlson index, source, etiology, presentation with severe sepsis or shock and inappropriate empirical treatment, acquisition type was not associated with an increase in 14-day or 30-day mortality. Only an stratified analysis of 14th-day mortality for Gram negatives BSI showed a statically significant difference (7% in CA vs 17% in HCA, p = 0,05). Factors independently related to inadequate empirical treatment in the community were: catheter source, cancer, and previous antimicrobial use; no association with HCA acquisition was found.
CONCLUSION
HCA acquisition in our cohort was not a predictor for either inappropriate empirical treatment or increased mortality. These results might reflect recent changes in therapeutic protocols and epidemiological changes in community pathogens. Further studies should focus on recognising CA BSI due to resistant organisms facilitating an early and adequate treatment in patients with CA resistant BSI.
背景
与严格的社区获得性（CA）血流感染（BSI）相比，医疗保健相关（HCA）BSI 与更高频率的抗生素耐药微生物和不适当的治疗有关，预后更差。社区（CO）-BSI 的流行病学和治疗方案的最近变化可能改变了这种关联。本研究的目的是分析我们地区 CA 和 HCA BSI 的病因、治疗和结局。
方法
在 2006-2007 年的 3 个月期间，进行了一项前瞻性多中心队列研究，纳入了所有成年患者的 CO-BSI 发作。观察变量为死亡率和不适当的经验性治疗。通过逻辑回归进行调整分析。
结果
共纳入 341 例 CO-BSI 病例。其中 56%（192 例）为 HCA 获得性。给予不适当的经验性治疗的比例为 16.7%（57 例）。第 14 天和第 30 天的全因死亡率分别为 16.4%（56 例）和 20%（71 例）。在校正年龄、Charlson 指数、来源、病因、严重脓毒症或休克表现和不适当的经验性治疗后，获得类型与 14 天或 30 天死亡率的增加无关。仅对革兰氏阴性菌 BSI 的第 14 天死亡率进行分层分析显示差异具有统计学意义（CA 为 7%，HCA 为 17%，p=0.05）。社区获得性经验性治疗不充分的独立相关因素为：导管源、癌症和先前使用抗菌药物；与 HCA 获得无关。
结论
在我们的队列中，HCA 获得不是不适当的经验性治疗或死亡率增加的预测因素。这些结果可能反映了治疗方案的最新变化和社区病原体的流行病学变化。进一步的研究应侧重于识别由于耐药菌引起的 CA BSI，以便在 CA 耐药 BSI 患者中尽早进行适当的治疗。
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