Hernandez C, Cobos-Trigueros N, Feher C, Morata L, De La Calle C, Marco F, Almela M, Soriano A, Mensa J, Del Rio A, Martinez J A
Department of Infectious Diseases, Hospital Clínic-IDIBAPS-Barcelona Centre for International Health Research (CRESIB), Barcelona University, Villarroel 170, 08036, Barcelona, Spain,
Eur J Clin Microbiol Infect Dis. 2014 Nov;33(11):1973-80. doi: 10.1007/s10096-014-2146-3. Epub 2014 Jun 8.
Bacteraemia of unknown origin is prevalent and has a high mortality rate. However, there are no recent reports focusing on this issue. From 2005 to 2011, all episodes of community onset bacteraemia of unknown origin (CO-BSI), diagnosed at a 700-bed university hospital were prospectively included. Risk factors for Enterobactericeae resistant to third-generation cephalosporins (3GCR-E), Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus spp, and predictors of mortality were assessed by logistic regression. Out of 4,598 consecutive episodes of CO-BSI, 745 (16.2 %) were of unknown origin. Risk factors for S. aureus were male gender (OR 2.26; 1.33-3.83), diabetes mellitus (OR 1.71; 1.01-2.91) and intravenous drug addiction (OR 17.24; 1.47-202); for P. aeruginosa were male gender (OR 2.19; 1.10-4.37) and health-care associated origin (OR 9.13; 3.23-25.83); for 3GCR-E was recent antibiotic exposure (OR 2.53; 1.47-4.35), while for enterococci, it was recent hospital admission (OR 3.02; 1.64-5.55). Seven and 30-day mortality were 8.1 % and 13.4 %, respectively. Age over 65 years (OR 2.13; 1.28-3.55), an ultimately or rapidly fatal underlying disease (OR 4.15; 2.23-7.60), bone marrow transplantation (OR 4.07; 1.24-13.31), absence of fever (OR 4.45; 2.25-8.81), shock on presentation (OR 10.48; 6.05-18.15) and isolation of S. aureus (OR 2.01; 1.00-4.04) were independently associated with mortality. In patients with bacteraemia of unknown origin, a limited number of clinical characteristics may be useful to predict its aetiology and to choose the appropriate empirical treatment. Although no modifiable prognostic factors have been found, management optimization of S. aureus should be considered a priority in this setting.
不明原因菌血症很常见且死亡率高。然而，近期并无聚焦于此问题的报告。2005年至2011年，前瞻性纳入了一所拥有700张床位的大学医院诊断的所有社区获得性不明原因菌血症（CO-BSI）病例。通过逻辑回归分析评估对第三代头孢菌素耐药的肠杆菌科细菌（3GCR-E）、铜绿假单胞菌、金黄色葡萄球菌和肠球菌属的危险因素以及死亡率的预测因素。在4598例连续的CO-BSI病例中，745例（16.2%）病因不明。金黄色葡萄球菌感染的危险因素为男性（比值比[OR]2.26；1.33 - 3.83）、糖尿病（OR 1.71；1.01 - 2.91）和静脉药物成瘾（OR 17.24；1.47 - 202）；铜绿假单胞菌感染的危险因素为男性（OR 2.19；1.10 - 4.37）和医疗保健相关来源（OR 9.13；3.23 - 25.83）；3GCR-E感染的危险因素为近期使用抗生素（OR 2.53；1.47 - 4.35），而肠球菌感染的危险因素为近期住院（OR 3.02；1.64 - 5.55）。7天和30天死亡率分别为8.1%和13.4%。65岁以上（OR 2.13；1.28 - 3.55）、最终或迅速致命的基础疾病（OR 4.15；2.23 - 7.60）、骨髓移植（OR 4.07；1.24 - 13.31）、无发热（OR 4.45；2.25 - 8.81）、就诊时休克（OR 10.48；6.05 - 18.15）和分离出金黄色葡萄球菌（OR 2.01；1.00 - 4.04）与死亡率独立相关。在不明原因菌血症患者中，有限数量的临床特征可能有助于预测其病因并选择合适的经验性治疗。虽然未发现可改变的预后因素，但在此情况下应优先考虑优化对金黄色葡萄球菌的管理。
