Dalager-Pedersen Michael, Koch Kristoffer, Thomsen Reimar Wernich, Schønheyder Henrik Carl, Nielsen Henrik
Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
BMJ Open. 2014 Jan 29;4(1):e004208. doi: 10.1136/bmjopen-2013-004208.
Little is known about the prognosis of community-acquired bacteraemia (CAB) in workforce adults. We assessed return to workforce, risk for sick leave, disability pension and mortality within 1 year after CAB in workforce adults compared with blood culture-negative controls and population controls.
Population-based cohort study.
North Denmark, 1996-2011.
We used population-based healthcare registries to identify all patients aged 20-58 years who had first-time blood cultures obtained within 48 h of medical hospital admission, and who were part of the workforce (450 bacteraemia exposed patients and 6936 culture-negative control patients). For each bacteraemia patient, we included up to 10 matched population controls.
Return to workforce, risk of sick leave, permanent disability pension and mortality within 1 year after bacteraemia. Regression analyses were used to compute adjusted relative risks (RRs) with 95% CIs.
One year after admission, 78% of patients with CAB, 85.7% of culture-negative controls and 96.8% of population controls were alive and in the workforce, and free from sick leave or disability pension. Compared with culture-negative controls, bacteraemia was associated with an increased risk for long-term sick leave (4-week duration, 40.2% vs 23.9%, adjusted RR, 1.51; CI 1.34 to 1.70) and an increased risk for mortality (30-day mortality, 4% vs 1.4%, adjusted RR, 2.34, CI 1.22 to 4.50; 1-year mortality, 8% vs 3.9%, adjusted RR, 1.73; CI 1.18 to 2.55). Bacteraemia patients had a risk for disability pension similar to culture-negative controls (2.7% vs 2.6%, adjusted RR, 0.99, CI 0.48 to 2.02) but greater than population controls (adjusted RR, 5.20; 95% CI 2.16 to 12.50).
CAB is associated with long duration of sick leave and considerable mortality in working-age adults when compared with blood culture-negative controls, and an increased 1-year risk for disability pension when compared with population controls.
对于在职成年人社区获得性菌血症（CAB）的预后了解甚少。我们评估了在职成年人CAB发生后1年内恢复工作、病假风险、残疾抚恤金和死亡率，并与血培养阴性对照和人群对照进行比较。
基于人群的队列研究。
丹麦北部，1996 - 2011年。
我们利用基于人群的医疗保健登记系统，识别所有年龄在20 - 58岁之间、在医院入院后48小时内首次进行血培养且为在职人员的患者（450例菌血症暴露患者和6936例培养阴性对照患者）。对于每例菌血症患者，我们纳入多达10名匹配的人群对照。
菌血症发生后1年内恢复工作、病假风险、永久性残疾抚恤金和死亡率。采用回归分析计算调整后的相对风险（RR）及95%置信区间（CI）。
入院1年后，78%的CAB患者、85.7%的培养阴性对照患者和96.8%的人群对照患者存活且在职，无病假或残疾抚恤金。与培养阴性对照相比，菌血症与长期病假风险增加相关（持续4周，40.2%对23.9%，调整后RR为1.51；CI为1.34至1.70），且死亡率增加（30天死亡率，4%对1.4%，调整后RR为2.34，CI为1.22至4.50；1年死亡率，8%对3.9%，调整后RR为1.73；CI为1.18至2.55）。菌血症患者获得残疾抚恤金的风险与培养阴性对照相似（2.7%对2.6%，调整后RR为0.99，CI为0.48至2.02），但高于人群对照（调整后RR为5.20；95%CI为2.16至12.50）。
与血培养阴性对照相比，CAB与在职成年人的病假时间延长和相当高的死亡率相关，与人群对照相比，1年残疾抚恤金风险增加。
