Gayfutdinov E A, Rudnov V A, Bagin V A
Anesteziol Reanimatol. 2015 Jul-Aug;60(4):33-7.
study of special aspects in system inflammatory reaction caused by nosocomial bacteremia in dependence of the pathogen Gram-origin. The study included 85 patients with nosocomial bacteremia in ICU from 2010 till 2012. The main inclusion criteria was bacteria identification in blood, which was taken more than 48 hours from arrival to ICU within the appearance of system inflammatory response signs. Key options for clinical rating of system inflammatory response was dynamic of patients condition according APACHE II, SOFA, SAPS-III/PIRO, Pitt scales and its correlation with durations of mechanical ventilation, length of staying in ICU, total hospital period and outcome.
Gram-negative microorganisms are definitely leading in the modern ethiological structure of nosocomial bacteremia in ICU patients (64,4%). The main origin of Gram(+) agents is central venous catheter infections. The main reason of Gram(-) infections is ventilation-associated pneumonia. Appearance or persistence of system inflammatory response is associated with the rise of scale indexes (SOFA and Pitt from 5 scores and higher and SAPS-PIRO higher than 18 scores) and high risk of possible bacteremia.
根据病原菌革兰氏起源，研究医院获得性菌血症引起的系统炎症反应的特殊方面。该研究纳入了2010年至2012年期间重症监护病房（ICU）的85例医院获得性菌血症患者。主要纳入标准是在出现系统炎症反应体征后，从入住ICU起超过48小时采集的血液中细菌鉴定。系统炎症反应临床评分的关键指标是根据急性生理与慢性健康状况评分系统II（APACHE II）、序贯器官衰竭评估（SOFA）、简化急性生理学评分-III/感染相关器官功能衰竭评分（SAPS-III/PIRO）、皮特评分（Pitt scales）评估的患者病情动态变化及其与机械通气时间、在ICU停留时间、总住院时间和预后的相关性。
革兰氏阴性微生物在ICU患者医院获得性菌血症的现代病因结构中占绝对主导地位（64.4%）。革兰氏阳性菌的主要来源是中心静脉导管感染。革兰氏阴性菌感染的主要原因是呼吸机相关性肺炎。系统炎症反应的出现或持续与评分指标升高（SOFA和皮特评分达到5分及以上，SAPS-PIRO评分高于18分）以及可能发生菌血症的高风险相关。
