García-Gómez Miriam, Guío Laura, Hernández José Luis, Vilar Begoña, Pijoán José Ignacio, Montejo José Miguel
Miriam García Gómez, Unidad de Enfermedades Infecciosas. Hospital Universitario Cruces. Plaza de Cruces s/n, 48903, Barakaldo. Bizkaia, Sapin.
Rev Esp Quimioter. 2015 Oct;28(5):256-62.
Bloodstream infections due to multire-sistant Enterobacteriaceae are a major matter of concern nowadays. The present study evaluated the impact of these infections in our area.
Prospective observational study of a cohort of patients with bacteraemia due to extended-spectrum beta-lactamases (ESBL) and other beta-lactamases producing organisms among hospitalized patients in Cruces Hospital for 2 years. We conducted a descriptive analysis, a subgroup analysis (cancer vs. non-cancer patients) and a mortality analysis.
During the study period, 3409 episodes of bacteraemia were diagnosed, of which 124 (3.6%) were ESBL and other beta-lactamases producing Enterobacteriaceae. 40.3% of the cases were nosocomial, 15.3% community acquired and 44.4% were health-care associated. 44.4% of the cohort had cancer as underlying disease. The most commonly isolated organism was E. coli (83% of cases), regardless of the source of infection. 58.1% of patients received inadequate empirical therapy. 7 day-mortality was 10.5% and 30 day-mortality was 21.8%. None of the analyzed variables showed association with 7 and 14 day-mortality, but the presence of solid cancer (p= 0.032) and advanced HIV infection (p = 0.027), were significantly associated with higher 30 day-mortality.
More than half of bacteraemia episodes affected outpatients and most of them were health-care associated episodes. Even though more than half of the patients received inadequate empirical treatment, this was not related to higher mortality. We only found an association between 30 day-mortality and the presence of underlying solid malignancy or advanced HIV infection.
由多重耐药肠杆菌科细菌引起的血流感染是当今主要关注的问题。本研究评估了这些感染在我们地区的影响。
对克鲁塞斯医院住院患者中因产超广谱β-内酰胺酶（ESBL）和其他产β-内酰胺酶微生物导致菌血症的患者队列进行了为期2年的前瞻性观察研究。我们进行了描述性分析、亚组分析（癌症患者与非癌症患者）和死亡率分析。
在研究期间，共诊断出3409例菌血症发作，其中124例（3.6%）是由产ESBL和其他β-内酰胺酶的肠杆菌科细菌引起的。40.3%的病例为医院获得性感染，15.3%为社区获得性感染，44.4%为医疗保健相关感染。44.4%的队列患者患有癌症作为基础疾病。无论感染源如何，最常分离出的病原体是大肠杆菌（83%的病例）。58.1%的患者接受了不恰当的经验性治疗。7天死亡率为10.5%，30天死亡率为21.8%。所分析的变量均未显示与7天和14天死亡率相关，但实体癌的存在（p = 0.032）和晚期HIV感染（p = 0.027）与较高的30天死亡率显著相关。
超过一半的菌血症发作影响门诊患者，且大多数为医疗保健相关发作。尽管超过一半的患者接受了不恰当的经验性治疗，但这与较高的死亡率无关。我们仅发现30天死亡率与潜在的实体恶性肿瘤或晚期HIV感染的存在之间存在关联。
