Umemura Takumi, Hamada Yukihiro, Yamagishi Yuka, Suematsu Hiroyuki, Mikamo Hiroshige
Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Japan; Department of Pharmacy, Tosei General Hospital, Japan.
Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
Anaerobe. 2016 Jun;39:45-50. doi: 10.1016/j.anaerobe.2016.02.007. Epub 2016 Feb 20.
The presence of anaerobes in the blood stream is known to be associated with a higher rate of mortality. However, few prognostic risk factor analyses examining whether a patient's background characteristics are associated with the prognosis have been reported. We performed a retrospective case-controlled study to assess the prognostic factors associated with death from anaerobic bacteremia. Seventy-four patients with anaerobic bacteremia were treated between January 2005 and December 2014 at Aichi Medical University Hospital. The clinical information included drug susceptibility was used for analysis of prognostic factors for 30-day mortality. Multivariate logistic analyses revealed an association between the 30-day mortality rate and malignancy (OR: 3.64, 95% CI: 1.08-12.31) and clindamycin resistance (OR: 7.93, 95% CI: 2.33-27.94). The result of Kaplan-Meier analysis of mortality showed that the 30-day survival rate was 83% in clindamycin susceptible and 38.1% in clindamycin resistant anaerobes causing bacteremia. The result of log-rank test also showed that susceptibility to clindamycin affected mortality (P < 0.001). Our results indicated that malignancy and clindamycin susceptibility could be used to identify subgroups of patients with anaerobic bacteremia with a higher risk of 30-day mortality. The results of this study are important for the early and appropriate management of patients with anaerobic bacteremia.
已知血流中存在厌氧菌与较高的死亡率相关。然而，很少有关于检查患者背景特征是否与预后相关的预后危险因素分析的报道。我们进行了一项回顾性病例对照研究，以评估与厌氧菌血症死亡相关的预后因素。2005年1月至2014年12月期间，爱知医科大学医院对74例厌氧菌血症患者进行了治疗。将包括药敏性在内的临床信息用于分析30天死亡率的预后因素。多因素逻辑分析显示，30天死亡率与恶性肿瘤（比值比：3.64，95%置信区间：1.08 - 12.31）和克林霉素耐药性（比值比：7.93，95%置信区间：2.33 - 27.94）之间存在关联。死亡率的Kaplan - Meier分析结果显示，引起菌血症的克林霉素敏感厌氧菌的30天生存率为83%，克林霉素耐药厌氧菌的为38.1%。对数秩检验结果也显示，对克林霉素的敏感性影响死亡率（P < 0.001）。我们的结果表明，恶性肿瘤和克林霉素敏感性可用于识别30天死亡率风险较高的厌氧菌血症患者亚组。本研究结果对于厌氧菌血症患者的早期和适当管理具有重要意义。
