Ballouz Tala, Aridi Jad, Afif Claude, Irani Jihad, Lakis Chantal, Nasreddine Rakan, Azar Eid
Department of Infectious Diseases, Saint George Hospital University Medical Center and University of BalamandBeirut, Lebanon.
Department of Family Medicine, Saint George Hospital University Medical Center and University of BalamandBeirut, Lebanon.
Front Cell Infect Microbiol. 2017 May 4;7:156. doi: 10.3389/fcimb.2017.00156. eCollection 2017.
Infections caused by (AB), an increasingly prevalent nosocomial pathogen, have been associated with high morbidity and mortality. We conducted this study to analyze the clinical features, outcomes, and factors influencing the survival of patients with AB bacteremia. We retrospectively examined the medical records of all patients developing AB bacteremia during their hospital stay at a tertiary care hospital in Beirut between 2010 and 2015. Ninety episodes of AB bacteremia were documented in eighty-five patients. Univariate analysis showed that prior exposure to high dose steroids, diabetes mellitus, mechanical ventilation, prior use of colistin and tigecycline, presence of septic shock, and critical care unit stay were associated with a poor outcome. High dose steroids and presence of septic shock were significant on multivariate analysis. Crude mortality rate was 63.5%. 70.3% of the deaths were attributed to the bacteremia. On acquisition, 39 patients had septicemia. Despite high index of suspicion and initiation of colistin and/or tigecycline in 18/39 patients, a grim outcome could not be averted and 37 patients died within 2.16 days. Seven patients had transient benign bacteremia; three of which were treated with removal of the line. The remaining four did not receive any antibiotics due to withdrawal of care and died within 26.25 days of acquiring the bacteremia, with no signs of persistent infection on follow up. A prolonged hospital stay is frequently associated with loss of functionality, and steroid and antibiotic exposure. These factors seem to impact the mortality of AB bacteremia, a disease with high mortality rate and limited therapeutic options.
由[具体细菌名称未给出]（AB）引起的感染是一种日益普遍的医院病原体，与高发病率和死亡率相关。我们开展这项研究以分析AB菌血症患者的临床特征、结局以及影响生存的因素。我们回顾性检查了2010年至2015年期间在贝鲁特一家三级护理医院住院期间发生AB菌血症的所有患者的病历。85例患者记录了90次AB菌血症发作。单因素分析显示，先前暴露于高剂量类固醇、糖尿病、机械通气、先前使用黏菌素和替加环素、存在感染性休克以及入住重症监护病房与不良结局相关。多因素分析显示高剂量类固醇和存在感染性休克具有显著意义。粗死亡率为63.5%。70.3%的死亡归因于菌血症。发病时，39例患者患有败血症。尽管高度怀疑并对18/39例患者启动了黏菌素和/或替加环素治疗，但仍无法避免严峻的结局，37例患者在2.16天内死亡。7例患者有短暂性良性菌血症；其中3例通过拔除导管进行治疗。其余4例因停止治疗未接受任何抗生素治疗，在菌血症发生后26.25天内死亡，随访时无持续感染迹象。住院时间延长常常与功能丧失、类固醇和抗生素暴露相关。这些因素似乎影响AB菌血症的死亡率，这是一种死亡率高且治疗选择有限的疾病。
