Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, Canada.
BMC Infect Dis. 2014 Jan 21;14:36. doi: 10.1186/1471-2334-14-36.
The independent influence of blood culture testing and bloodstream infection (BSI) on hospital mortality is unclear.
We included all adults treated in non-psychiatric services at our hospital between 2004 and 2011. We identified all blood cultures and their results to determine the independent association of blood culture testing and BSI on death in hospital using proportional hazards modeling that adjusted for important covariates.
Of 297 070 hospitalizations, 48 423 had negative blood cultures and 5274 had BSI. 12 529 (4.2%) died in hospital. Compared to those without blood cultures, culture-negative patients and those with BSI were sicker. Culture-negative patients had a significantly increased risk of death in hospital (adjusted hazard ratio [HR] ranging between 3.1 and 4.4 depending on admission urgency, extent of comorbidities, and whether the blood culture was taken in the intensive care unit). Patients with BSI had a significantly increased risk of death (adj-HR ranging between 3.8 and 24.3] that was significantly higher when BSI was: diagnosed within the first hospital day; polymicrobial; in patients who were exposed to immunosuppressants or were neutropenic; or due to Clostridial and Candidal organisms. Death risk in culture negative and bloodstream infection patients decreased significantly with time.
Risk of death in hospital is independently increased both in patients with negative blood cultures and further in those with bloodstream infection. Death risk associated with bloodstream infections varied by the patient's immune status and the causative microorganism.
血液培养检测和血流感染（BSI）对医院死亡率的独立影响尚不清楚。
我们纳入了 2004 年至 2011 年期间在我院非精神科接受治疗的所有成年人。我们确定了所有的血液培养物及其结果，以使用比例风险模型确定血液培养检测和 BSI 对医院内死亡的独立关联，该模型调整了重要的协变量。
在 297070 例住院患者中，48423 例血培养阴性，5274 例发生 BSI。12529 例（4.2%）在医院死亡。与未进行血培养的患者相比，培养阴性的患者和发生 BSI 的患者病情更严重。培养阴性的患者在医院死亡的风险显著增加（调整后的危险比[HR]范围在 3.1 到 4.4 之间，取决于入院的紧急程度、合并症的严重程度以及血培养是否在重症监护病房进行）。发生 BSI 的患者死亡的风险显著增加（调整后的 HR 范围在 3.8 到 24.3 之间），当 BSI：在入院的第一日内诊断；为混合感染；发生在接受免疫抑制剂或中性粒细胞减少的患者中；或由梭菌和假丝酵母菌引起时，风险更高。培养阴性和血流感染患者的死亡风险随时间显著降低。
阴性血培养和进一步的血流感染患者的住院死亡风险均独立增加。与血流感染相关的死亡风险因患者的免疫状态和病原体而异。
