Rates, predictors and mortality of community-onset bloodstream infections due to Pseudomonas aeruginosa: systematic review and meta-analysis. 铜绿假单胞菌引起的社区获得性血流感染的发生率、预测因素和死亡率：系统评价和荟萃分析。
Rates, predictors and mortality of community-onset bloodstream infections due to Pseudomonas aeruginosa: systematic review and meta-analysis.
机构信息
Departamento de Enfermedades Infecciosas del Adulto, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
出版信息
Clin Microbiol Infect. 2019 Aug;25(8):964-970. doi: 10.1016/j.cmi.2019.04.005. Epub 2019 Apr 14.
BACKGROUND
Pseudomonas aeruginosa is mostly a nosocomial pathogen affecting predisposed patients. However, community-onset bloodstream infections (CO-BSI) caused by this organism are not exceptional.
OBJECTIVES
To assess the predisposing factors for CO-BSI due to P. aeruginosa (CO-BSI-PA) and the impact in mortality of inappropriate empirical antimicrobial therapy.
DATA SOURCE
A systematic literature search was performed in the Medline, Embase, Cochrane Library, Scopus and Web of Science databases. Study eligibility criteria and participants: Articles published between 1 January 2002 and 31 January 2018 reporting at least of 20 adult patients with CO-BSI due to P. aeruginosa were considered.
INTERVENTION
Empiric antimicrobial therapy for CO-BSI-PA.
METHODS
A systematic review and a meta-analysis were conducted for risk factors and to evaluate if inappropriate empiric antimicrobial therapy increased mortality in CO-BSI-PA using a Mantel-Haenszel effects model.
RESULTS
Twelve studies assessing data of 1120 patients were included in the systematic review. Solid tumour (33.1%), haematologic malignancy (26.4%), neutropenia (31.7%) and previous antibiotic use (44.8%) were the most prevalent predisposing factors. Septic shock was present in 42.3% of cases, and 30-day crude mortality was 33.8%. Mortality in meta-analysis (four studies) was associated with septic shock at presentation (odds ratio, 22.31; 95% confidence interval, 3.52-141.35; p 0.001) and with inappropriate empiric antibiotic therapy (odds ratio, 1.83; 95% confidence interval, 1.12-2.98l p 0.02).
CONCLUSIONS
CO-BSI-PA mostly occurred in patients with predisposing factors and had a 30-day mortality comparable to hospital-acquired cases. Inappropriate empirical antibiotic therapy was associated with increased mortality. Appropriate identification of patients at risk for CO-BSI-PA is needed for empirical treatment decisions.
背景
铜绿假单胞菌主要是一种医院获得性病原体，影响易感染的患者。然而，由该病原体引起的社区获得性血流感染（CO-BSI）也并不罕见。
目的
评估铜绿假单胞菌引起的社区获得性血流感染（CO-BSI-PA）的易患因素，以及不适当经验性抗菌治疗对死亡率的影响。
数据来源
对 Medline、Embase、Cochrane 图书馆、Scopus 和 Web of Science 数据库进行了系统文献检索。研究入选标准和参与者：纳入 2002 年 1 月 1 日至 2018 年 1 月 31 日期间至少报告 20 例成人铜绿假单胞菌引起的 CO-BSI 的文章。
干预措施
CO-BSI-PA 的经验性抗菌治疗。
方法
采用系统评价和荟萃分析，采用 Mantel-Haenszel 效应模型评估危险因素，并评估 CO-BSI-PA 中不适当经验性抗菌治疗是否增加死亡率。
结果
12 项研究共纳入 1120 例患者的数据，纳入系统评价。最常见的易患因素包括实体瘤（33.1%）、血液恶性肿瘤（26.4%）、中性粒细胞减少症（31.7%）和既往抗生素使用（44.8%）。42.3%的患者存在感染性休克，30 天粗死亡率为 33.8%。荟萃分析（四项研究）中，死亡率与发病时感染性休克相关（比值比，22.31；95%置信区间，3.52-141.35；p<0.001）和不适当经验性抗生素治疗相关（比值比，1.83；95%置信区间，1.12-2.98；p=0.02）。
结论
CO-BSI-PA 主要发生在有易患因素的患者中，30 天死亡率与医院获得性感染相当。不适当的经验性抗生素治疗与死亡率增加相关。需要适当识别 CO-BSI-PA 的高危患者，以便做出经验性治疗决策。
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