Fukui Sayato, Uehara Yuki, Fujibayashi Kazutoshi, Takahashi Osamu, Hisaoka Teruhiko, Naito Toshio
Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan.
Department of General Medicine, Juntendo University School of Medicine, Tokyo, Japan Department of Infection Control Science, Faculty of Medicine, Juntendo University, Tokyo, Japan.
BMJ Open. 2016 Jul 7;6(7):e010527. doi: 10.1136/bmjopen-2015-010527.
The precise criteria for obtaining blood cultures have not been established; they depend on the physician's judgement. We examined clinical parameters to determine predictive factors of bacteraemia and the need for blood cultures among general medical inpatients.
A retrospective cross-sectional survey.
A Japanese university hospital.
All general inpatients who had blood cultures taken from 1 January 2011 to 31 December 2012.
Clinical information at or just before blood culture sampling was extracted from medical charts. Factors potentially predictive of bacteraemia were analysed using Fisher's exact test, followed by multivariable logistic regression model analysis.
A total of 200 patients (male: female=119:81, 64.3±19.1 years old) comprised this study; 57 (28.5%) had positive blood culture results. Multivariable logistic regression analysis revealed that age >60 years (OR=2.75, 95% CI 1.23 to 6.48, p=0.015), female sex (OR=2.21, 95% CI 1.07 to 4.67, p=0.038), pulse rate >90 bpm (OR=5.18, 95% CI 2.25 to 12.48, p<0.001) and neutrophil percentage >80% (OR=3.61, 95% CI 1.71 to 8.00, p=0.001) were independent risk factors for positive blood culture results. The area under the receiver operating characteristic curve analysis of this model was 0.796.
Our results emphasise the importance of taking blood cultures if the pulse rate is >90 bpm, in elderly patients and in women, and for ordering a differential white cell count.
获取血培养的精确标准尚未确立；这取决于医生的判断。我们研究了临床参数，以确定普通内科住院患者菌血症的预测因素以及血培养的必要性。
一项回顾性横断面调查。
一家日本大学医院。
2011年1月1日至2012年12月31日期间进行血培养的所有普通住院患者。
从病历中提取血培养采样时或采样前的临床信息。使用Fisher精确检验分析菌血症的潜在预测因素，随后进行多变量逻辑回归模型分析。
本研究共纳入200例患者（男∶女 = 119∶81，年龄64.3±19.1岁）；57例（28.5%）血培养结果呈阳性。多变量逻辑回归分析显示，年龄>60岁（比值比[OR]=2.75，95%置信区间[CI] 1.23至6.48，p = 0.015）、女性（OR = 2.21，95% CI 1.07至4.67，p = 0.038）、脉搏率>90次/分钟（OR = 5.18，95% CI 2.25至12.48，p<0.001）和中性粒细胞百分比>80%（OR = 3.61，95% CI 1.71至8.00，p = 0.001）是血培养结果呈阳性的独立危险因素。该模型的受试者工作特征曲线分析下的面积为0.796。
我们的结果强调，对于脉搏率>90次/分钟的患者、老年患者、女性患者进行血培养以及进行白细胞分类计数的重要性。
