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生命体征:脓毒症的流行病学:卫生保健因素的流行情况和预防机会。

Vital Signs: Epidemiology of Sepsis: Prevalence of Health Care Factors and Opportunities for Prevention.

出版信息

MMWR Morb Mortal Wkly Rep. 2016 Aug 26;65(33):864-9. doi: 10.15585/mmwr.mm6533e1.

Abstract

BACKGROUND

Sepsis is a serious and often fatal clinical syndrome, resulting from infection. Information on patient demographics, risk factors, and infections leading to sepsis is needed to integrate comprehensive sepsis prevention, early recognition, and treatment strategies.

METHODS

To describe characteristics of patients with sepsis, CDC and partners conducted a retrospective chart review in four New York hospitals. Random samples of medical records from adult and pediatric patients with administrative codes for severe sepsis or septic shock were reviewed.

RESULTS

Medical records of 246 adults and 79 children (aged birth to 17 years) were reviewed. Overall, 72% of patients had a health care factor during the 30 days before sepsis admission or a selected chronic condition likely to require frequent medical care. Pneumonia was the most common infection leading to sepsis. The most common pathogens isolated from blood cultures were Escherichia coli in adults aged ≥18 years, Klebsiella spp. in children aged ≥1 year, and Enterococcus spp. in infants aged <1 year; for 106 (33%) patients, no pathogen was isolated. Eighty-two (25%) patients with sepsis died, including 65 (26%) adults and 17 (22%) infants and children.

CONCLUSIONS

Infection prevention strategies (e.g., vaccination, reducing transmission of pathogens in health care environments, and appropriate management of chronic diseases) are likely to have a substantial impact on reducing sepsis. CDC, in partnership with organizations representing clinicians, patients, and other stakeholders, is launching a comprehensive campaign to demonstrate that prevention of infections that cause sepsis, and early recognition of sepsis, are integral to overall patient safety.

摘要

背景

败血症是一种严重且常致命的临床综合征,由感染引起。为整合全面的败血症预防、早期识别和治疗策略,我们需要了解败血症患者的人口统计学特征、风险因素和导致败血症的感染情况。

方法

为描述败血症患者的特征,美国疾病控制与预防中心(CDC)与合作伙伴在纽约的 4 家医院开展了回顾性病历审查。对成人和儿科患者的医疗记录进行了随机抽样,这些患者的行政代码为严重败血症或败血症性休克。

结果

共审查了 246 例成人和 79 例儿童(年龄从出生到 17 岁)的病历。总体而言,72%的患者在败血症入院前 30 天内存在医疗保健因素或患有可能需要频繁医疗护理的选定慢性病。导致败血症的最常见感染是肺炎。从血培养中分离出的最常见病原体为成人(年龄≥18 岁)的大肠杆菌、儿童(年龄≥1 岁)的克雷伯菌属和婴儿(年龄<1 岁)的肠球菌属;106 例(33%)患者未分离出病原体。82 例败血症患者死亡,包括 65 例成人和 17 例婴儿和儿童。

结论

感染预防策略(例如,接种疫苗、减少医疗机构病原体传播和适当管理慢性病)可能对降低败血症的发生有重大影响。CDC 正在与代表临床医生、患者和其他利益相关者的组织合作,开展一项全面的活动,以证明预防导致败血症的感染和早期识别败血症是整体患者安全的重要组成部分。

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