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涉及复杂性腹腔内感染患者的多微生物菌血症:频率、合并病原体、危险因素和临床结局。

Polymicrobial Bacteremia Involving in Patients with Complicated Intra-Abdominal Infections: Frequency, Co-Pathogens, Risk Factors, and Clinical Outcomes.

机构信息

1 Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.

2 Department of Surgery, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China.

出版信息

Surg Infect (Larchmt). 2019 May/Jun;20(4):317-325. doi: 10.1089/sur.2018.207. Epub 2019 Feb 8.

DOI:10.1089/sur.2018.207
PMID:30735082
Abstract

has gained notoriety because of its high antibiotic resistance and mortality. We compared the clinical features and outcomes of polymicrobial bacteremia involving (PBKP). A retrospective observational study of patients with polymicrobial and monomicrobial bacteremia involving from January 2012 to December 2016 was performed. The expression of resistance and virulence genes of 27 strains was also compared by polymerase chain reaction (PCR). Among the polymicrobial group, the most common accompanying micro-organism was . No differences in the expression of resistance and virulence genes was found among the 27 strains collected from the group. The analysis of the outcomes revealed that the patients with PBKP were more likely to have recurrent blood stream infections (p = 0.038), longer intensive care unit (ICU) lengths of stay (p = 0.043), and a higher total hospitalization cost (p = 0.045). However, no substantial differences in mortality were found between the two groups. The multivariable analysis revealed that a longer hospital stay prior to the onset of bacteremia (>20 days) was an independent risk factor for PBKP (p = 0.034), and the Sequential Organ Failure Assessment (SOFA) score upon onset of infection (p = 0.013), the adequacy of source control (p < 0.001), and iron supplementation (p = 0.003) were identified as independent predictors of mortality in patients with KP bacteremia. The development of septic shock and the concomitant use of iron supplementation are associated with higher mortality in patients with KP bacteremia, and PBKP did not increase the mortality of these patients, possibly because of the ability of to obscure the effects of other bacteria. Thus, adequate source control is more important than high-dose antibiotic therapy and is linked to higher survival.

摘要

由于其高抗生素耐药性和高死亡率, 已声名狼藉。我们比较了涉及 (PBKP)的多微生物菌血症的临床特征和结局。对 2012 年 1 月至 2016 年 12 月期间涉及多微生物和单微生物菌血症的患者进行了回顾性观察性研究。还通过聚合酶链反应(PCR)比较了 27 株菌的耐药性和毒力基因表达。在多微生物组中,最常见的伴随微生物是 。从该组收集的 27 株菌的耐药性和毒力基因表达无差异。结果分析表明,PBKP 患者更有可能发生反复血流感染(p=0.038),入住重症监护病房(ICU)的时间更长(p=0.043),总住院费用更高(p=0.045)。但是,两组之间的死亡率没有明显差异。多变量分析显示,菌血症发病前的住院时间较长(>20 天)是 PBKP 的独立危险因素(p=0.034),感染时的序贯器官衰竭评估(SOFA)评分(p=0.013)、源控制的充分性(p<0.001)和铁补充(p=0.003)是 KP 菌血症患者死亡的独立预测因子。感染性休克的发生和铁补充的同时使用与 KP 菌血症患者的死亡率较高相关,而 PBKP 并未增加这些患者的死亡率,这可能是由于 能够掩盖其他细菌的作用。因此,充分的源头控制比大剂量抗生素治疗更为重要,与更高的生存率相关。

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