Lin Hui-Wen, Hsu Hsin-Sui, Huang Yu-Tsung, Yang Chia-Jui, Hsu Meng-Shiuan, Liao Chun-Hsing
Division of Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Division of Infectious Diseases, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming University, Taipei, Taiwan.
J Microbiol Immunol Infect. 2016 Jun;49(3):417-23. doi: 10.1016/j.jmii.2014.08.004. Epub 2014 Oct 12.
Nontyphoidal Salmonella (NTS) is an important bacterial etiology of diarrheal disease, and it causes invasive diseases in immunocompromised hosts. For bacteremia from some species, blood culture with a rapid time to positivity (TTP) is associated with greater mortality. This study investigated TTP of NTS bacteremia and its relationship to clinical parameters and prognosis.
Adult patients with NTS bacteremia who were admitted to a tertiary care facility in northern Taiwan from January 2010 to December 2012 were enrolled. Demographics, clinical and microbiological characteristics, and treatment response were reviewed. The TTP for each patient was retrieved from the automated machine.
Sixty-six adult patients (mean age, 66.1 years; range, 27-96 years) with NTS bacteremia were identified by the following serogroup distributions: serogroup B (23.4%), serogroup C1 (1.6%), serogroup C2 (6.3%), and serogroup D (68.8%). The in-hospital mortality, 14-day mortality, and 30-day mortality were 15.2%, 7.6%, and 12.1%, respectively. The TTP ranged 6.5-41.7 hours (median: 11.5 hours). Patients with rapid TTP (less than 10 hours), compared to patients without rapid TTP, were more likely to have liver cirrhosis (31.6% vs. 6.4%, p = 0.013), endovascular lesions (21.1% vs. 4.3%, p = 0.05), higher bacteremia score, intensive care unit admission (57.9% vs. 25.5%, p = 0.021), and septic shock (63.2% vs. 12.8%, p < 0.001). There were no significant differences in the in-hospital mortality and 14-day mortality between patients with TTP <10 hours and patients with TTP ≥10 hours.
The TTP of blood cultures, interpreted with a cut-off point of <10 hours, in patients with NTS bacteremia may provide useful diagnostic and prognostic information.
非伤寒沙门氏菌（NTS）是腹泻病的重要细菌病因，且可在免疫功能低下的宿主中引发侵袭性疾病。对于某些菌种所致的菌血症，血培养阳性时间（TTP）较快与更高的死亡率相关。本研究调查了NTS菌血症的TTP及其与临床参数和预后的关系。
纳入2010年1月至2012年12月间入住台湾北部一家三级医疗机构的NTS菌血症成年患者。回顾患者的人口统计学、临床和微生物学特征以及治疗反应。从自动仪器中获取每位患者的TTP。
共识别出66例NTS菌血症成年患者（平均年龄66.1岁；范围27 - 96岁），其血清群分布如下：B群（23.4%）、C1群（1.6%）、C2群（6.3%）和D群（68.8%）。住院死亡率、14天死亡率和30天死亡率分别为15.2%、7.6%和12.1%。TTP范围为6.5 - 41.7小时（中位数：11.5小时）。与TTP不快速（超过10小时）的患者相比，TTP快速（少于10小时）的患者更可能患有肝硬化（31.6%对6.4%，p = 0.013）、血管内病变（21.1%对4.3%，p = 0.05）、菌血症评分更高、入住重症监护病房（57.9%对25.5%，p = 0.021）以及感染性休克（63.2%对12.8%，p < 0.001）。TTP < 10小时的患者与TTP≥10小时的患者在住院死亡率和14天死亡率方面无显著差异。
对于NTS菌血症患者，血培养TTP以< 10小时为界值进行解读，可能提供有用诊断和预后信息。
