Tago Sayaka, Hirai Yuji, Ainoda Yusuke, Fujita Takahiro, Kikuchi Ken
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan.
Department of Infectious Diseases, Tokyo Women's Medical University, Tokyo, Japan.
J Microbiol Immunol Infect. 2017 Jun;50(3):333-338. doi: 10.1016/j.jmii.2015.07.008. Epub 2015 Aug 4.
BACKGROUND/PURPOSE: Our aim was to describe the clinical features and prognostic factors of Gram-negative rod bacteremia (GNRB) after cardiovascular surgery (CVS).
This retrospective observational study included adults with GNRB onset within 100 days after CVS at a single institution from April 2004 to May 2013. Clinical data regarding episodes of GNRB were collected from patients' medical charts. Those having polymicrobial bacteremia with a bacterium other than a GNR were excluded.
Among 2017 CVS patients, GNRB occurred in 78. Klebsiella, Pseudomonas aeruginosa, Enterobacter, and Escherichia coli were the most commonly isolated organisms. Graft replacement was the most common surgical procedure in patients with GNRB after CVS (44.9%). Prophylaxis antibiotics were ampicillin/sulbactam (76.9%), and vancomycin (12.8%). The crude 90-day mortality rate was 21.8%, and the mean Acute Physiology and Chronic Health Evaluation II score was 15.6 (range, 3-39). In 34.6% of patients, the same GNR species were isolated from other samples within 30 days of GNRB occurrence. Multivariate analysis indicated that P. aeruginosa bacteremia [odds ratio (OR), 175; confidence interval (CI), 2.40-1270; p = 0.0182], Acute Physiology and Chronic Health Evaluation II scores of ≥ 25 (OR 76.2; CI 1.04-5580; p = 0.0479), and vancomycin for prophylaxis (OR 45.4; CI 1.02-202; p = 0.0488) were significant independent prognostic factors associated with death due to GNRB after CVS.
Graft replacement was the most common surgical procedure in patients with GNRB after CVS. Empirical antibiotics covering Gram-negative rods including P. aeruginosa should be considered if bacteremia is suspected in unstable patients after CVS.
背景/目的：我们的目的是描述心血管手术后革兰氏阴性杆菌血症（GNRB）的临床特征和预后因素。
这项回顾性观察研究纳入了2004年4月至2013年5月在单一机构内心血管手术后100天内发生GNRB的成年人。从患者病历中收集有关GNRB发作的临床数据。排除那些患有除GNR之外的其他细菌的混合菌血症患者。
在2017例心血管手术患者中，78例发生了GNRB。克雷伯菌、铜绿假单胞菌、肠杆菌和大肠杆菌是最常分离出的病原体。血管移植置换术是心血管手术后发生GNRB患者中最常见的手术方式（44.9%）。预防性使用的抗生素为氨苄西林/舒巴坦（76.9%）和万古霉素（12.8%）。90天粗死亡率为21.8%，急性生理与慢性健康状况评分II（APACHE II）的平均分值为15.6（范围为3 - 39）。在34.6%的患者中，在GNRB发生后30天内从其他样本中分离出相同的GNR菌种。多因素分析表明，铜绿假单胞菌血症[比值比（OR）为175；置信区间（CI）为2.40 - 1270；p = 0.0182]、APACHE II评分≥25（OR为76.2；CI为1.04 - 5580；p = 0.0479）以及预防性使用万古霉素（OR为45.4；CI为1.02 - 202；p = 0.0488）是与心血管手术后因GNRB死亡相关的显著独立预后因素。
血管移植置换术是心血管手术后发生GNRB患者中最常见的手术方式。对于心血管手术后不稳定且怀疑有菌血症的患者，应考虑使用覆盖包括铜绿假单胞菌在内的革兰氏阴性杆菌的经验性抗生素。
