Kim June-Sung, Kim Youn-Jung, Ryoo Seung Mok, Sohn Chang Hwan, Ahn Shin, Seo Dong Woo, Lim Kyoung Soo, Kim Won Young
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea.
J Clin Med. 2019 Feb 3;8(2):181. doi: 10.3390/jcm8020181.
(1) Background: Septic shock survivors frequently readmit because of subsequent infection. This study aimed to determine the rate and risk factors for same pathogen sepsis readmissions following hospitalization for septic shock. (2) Methods: We performed this retrospective study using data from a prospective septic shock registry at a single urban tertiary center. All the patients were treated with a protocol-driven resuscitation bundle therapy between 2011 and 2016. We collected data from adult (older than 18 years) patients readmitted with sepsis within 90 days of discharge following hospitalization for septic shock. (3) Results: Among 2062 septic shock patients, 690 were readmitted within 90 days of discharge. After excluding scheduled and non-sepsis admissions, we analyzed the data from 274 (13.3%) patients readmitted for sepsis. Most of the readmissions following septic shock were new infections rather than relapses of the initial infection. The culture-negative rate was 51.4% (141/274), while the same pathogen was isolated in 25% of cases (69/274). Multivariate analysis revealed that previous gram-negative bacteremia (OR, 9.902; 95% CI, 2.843⁻34.489), urinary tract infection (OR, 4.331; 95% CI, 1.723⁻10.882) and same site infection (OR, 6.894; 95% CI, 2.390⁻19.886) were significantly associated with readmission for sepsis caused by the same pathogen. (4) Conclusions: The sepsis readmission rate following the previous hospitalization for septic shock was 13.3% and one-quarter of those patients had the same pathogen isolated. Previous gram-negative bacteremia, and/or same site infection are predisposing factors for recurrent same-pathogen sepsis.
(1) 背景：感染性休克幸存者常因后续感染再次入院。本研究旨在确定感染性休克住院后同一病原体败血症再入院的发生率及危险因素。(2) 方法：我们利用一家城市三级中心前瞻性感染性休克登记处的数据进行了这项回顾性研究。2011年至2016年期间，所有患者均接受了方案驱动的复苏集束治疗。我们收集了因感染性休克住院出院后90天内再次入院的成年（年龄大于18岁）败血症患者的数据。(3) 结果：在2062例感染性休克患者中，690例在出院后90天内再次入院。排除计划性和非败血症性入院后，我们分析了274例（13.3%）因败血症再次入院患者的数据。感染性休克后的大多数再入院是新感染而非初始感染的复发。血培养阴性率为51.4%（141/274），25%的病例（69/274）分离出同一病原体。多因素分析显示，既往革兰阴性菌血症（OR，9.902；95%CI，2.843⁻34.489）、尿路感染（OR，4.331；95%CI，1.723⁻10.882）和同一部位感染（OR，6.894；95%CI，2.390⁻19.886）与同一病原体引起的败血症再入院显著相关。(4) 结论：既往感染性休克住院后的败血症再入院率为13.3%，其中四分之一的患者分离出同一病原体。既往革兰阴性菌血症和/或同一部位感染是复发性同一病原体败血症的易感因素。
