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感染的临床特征与实验室鉴定:澳大利亚一家三级医疗中心的视角

Clinical Characteristics and Laboratory Identification of Infections: An Australian Tertiary Centre Perspective.

作者信息

Narayanasamy Shanti, King Katherine, Dennison Amanda, Spelman Denis W, Aung Ar Kar

机构信息

Department of Infectious Disease, The Alfred Hospital, Melbourne, VIC, Australia.

Microbiology Unit, The Alfred Hospital, Melbourne, VIC, Australia.

出版信息

Int J Microbiol. 2017;2017:5684614. doi: 10.1155/2017/5684614. Epub 2017 Sep 13.

Abstract

Aerococci uncommonly cause urinary tract (UTI) and bloodstream infections (BSI). The clinical characteristics and laboratory identification rates of in the Australian context are unknown. A retrospective observational cohort study of patients with positive cultures between 2010 and 2015 was performed. Patients were analysed according to predefined "asymptomatic bacteriuria," "UTI," and "BSI" groups. Forty-seven [40 (85%) for urine and 7 (15%) for blood] isolates were identified [38% male, median age of 79 (IQR 62-85) years], with corresponding identification rates of 24.2/100,000/year for urine (0.02%) and 7.3/100,000/year for blood cultures (0.007%). Since the use of matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS) identification rate in urine has increased from 14.7/100,000/year to 32/100,000/year ( = 0.02). For urine isolates, 14 (35%) met the definition for UTI whilst 26 (65%) were "asymptomatic bacteriuria." Underlying urological abnormalities, catheterisation, and polymicrobial growth were common. Seventy percent of bacteriuria was treated regardless of colonisation or active infection status. Symptomatic patients were more likely to receive treatment (OR 7.2, 95% CI 1.4-35.3). In patients with BSI, 1 (14.2%) had endocarditis and 1 (14.2%) died. The majority of isolates were susceptible to penicillin (11/12 tested, 92%).

摘要

气球菌很少引起尿路感染(UTI)和血流感染(BSI)。在澳大利亚背景下,其临床特征和实验室鉴定率尚不清楚。对2010年至2015年间培养结果呈阳性的患者进行了一项回顾性观察队列研究。根据预先定义的“无症状菌尿”、“UTI”和“BSI”组对患者进行分析。共鉴定出47株分离菌[尿液分离菌40株(85%),血液分离菌7株(15%)] [男性占38%,中位年龄79岁(四分位间距62 - 85岁)],尿液分离菌的相应鉴定率为每年24.2/10万(0.02%),血培养的鉴定率为每年7.3/10万(0.007%)。自从使用基质辅助激光解吸电离飞行时间质谱(MALDI - TOF MS)以来,尿液中的鉴定率已从每年14.7/10万提高到32/10万(P = 0.02)。对于尿液分离菌,14株(35%)符合UTI的定义,而26株(65%)为“无症状菌尿”。潜在的泌尿系统异常、导尿和混合菌生长很常见。70%的菌尿患者无论处于定植状态还是有活动性感染均接受了治疗。有症状的患者更有可能接受治疗(比值比7.2,95%置信区间1.4 - 35.3)。在BSI患者中,1例(14.2%)患有心内膜炎,1例(14.2%)死亡。大多数分离菌对青霉素敏感(12株中有11株检测,92%)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2bd9/5615948/94cc852ba7dc/IJMICRO2017-5684614.001.jpg

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