Lee Ching-Chi, Hsieh Chih-Chia, Lee Nan-Yao, Chan Tsung-Yu, Hong Ming-Yuan, Chi Chih-Hsien, Ko Wen-Chien
Department of Internal Medicine and Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.
Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
Am J Emerg Med. 2015 Jul;33(7):907-12. doi: 10.1016/j.ajem.2015.03.058. Epub 2015 Apr 6.
To analyze the differences in clinical presentation and characteristics of community-onset bacteremia between neutropenic and nonneutropenic adults visiting the emergency department.
A case-control study with a ratio of 1:2 was conducted retrospectively over a 6-year period. Demographic characteristics, microorganisms, severity of illness, and clinical outcomes determined from medical records were analyzed.
In total, 116 neutropenic adults (case patients) and 232 nonneutropenic adults (control patients) were examined. Significant differences in the source of bacteremia, susceptibility, and species of bacteremia-causing organisms between the case patients and control patients were observed by univariate analyses. Significantly more patients presenting with an initial syndrome of severe sepsis or septic shock at the emergency department, having high Pittsburgh bacteremia scores (≥4 points) or having severe comorbidities (McCabe classification), and high 28-day mortality rates were discovered in the case group, compared with the control group. Of note, Pseudomonas aeruginosa (32/137 [23.4%] vs 8/272 [2.9%], P < .001) was more often isolated from the case patients. In a further analysis using a multivariate regression to demonstrate the independent predictors of P aeruginosa infection, patients with neutropenia remained as an independent risk factors (odds ratio, 7.48; P < .001).
This study demonstrated obvious differences of community-onset bacteremia in severity, the distribution of microorganisms, and susceptibility between neutropenic and nonneutropenic patients. Antipseudomonas therapy was empirically suggested for neutropenic patients with community-onset bacteremia and reducing the need for a glycopeptide.
分析急诊科就诊的中性粒细胞减少和非中性粒细胞减少的成年社区获得性菌血症患者的临床表现及特征差异。
进行一项回顾性病例对照研究，病例与对照比例为1:2，为期6年。分析病历中确定的人口统计学特征、微生物、疾病严重程度和临床结局。
共检查了116例中性粒细胞减少的成年患者（病例组）和232例非中性粒细胞减少的成年患者（对照组）。单因素分析观察到病例组和对照组在菌血症来源、药敏性及引起菌血症的生物体种类方面存在显著差异。与对照组相比，病例组中在急诊科表现为严重脓毒症或脓毒性休克初始综合征、匹兹堡菌血症评分高（≥4分）或有严重合并症（麦凯布分类）以及28天死亡率高的患者明显更多。值得注意的是，铜绿假单胞菌在病例组中分离率更高（32/137 [23.4%] 对8/272 [2.9%]，P <.001）。在进一步使用多因素回归分析以证明铜绿假单胞菌感染的独立预测因素时，中性粒细胞减少患者仍然是独立危险因素（比值比，7.48；P <.001）。
本研究表明，中性粒细胞减少和非中性粒细胞减少患者的社区获得性菌血症在严重程度、微生物分布及药敏性方面存在明显差异。对于社区获得性菌血症的中性粒细胞减少患者，经验性建议采用抗铜绿假单胞菌治疗并减少糖肽类药物的使用。
