Capsoni Nicolò, Bellone Pietro, Aliberti Stefano, Sotgiu Giovanni, Pavanello Donatella, Visintin Benedetto, Callisto Elena, Saderi Laura, Soldini Davide, Lardera Luca, Monzani Valter, Brambilla Anna Maria
1Department of Emergency Medicine, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Respiratory Unit and Cystic Fibrosis Adult Center, Via Francesco Sforza 35, 20122 Milan, Italy.
Multidiscip Respir Med. 2019 Jul 5;14:23. doi: 10.1186/s40248-019-0185-4. eCollection 2019.
Although previous studies showed an increasing prevalence of infections due to multi-drug resistant (MDR) bacteria in the community, specific data on sepsis are lacking. We aimed to assess prevalence, risk factors and outcomes of patients with sepsis due to MDR bacteria.
An observational, retrospective study was conducted on consecutive adult patients coming from the community and admitted to the Policlinico Hospital, Milan, Italy, with a diagnosis of sepsis between January 2011 and December 2015. Primary study outcome was in-hospital mortality.
Among 518 patients, at least one MDR bacteria was isolated in 88 (17%). ESBL+ were the most prevalent MDR bacteria (9.7%) followed by MRSA (3.9%). Independent risk factors for sepsis due to MDR bacteria were septic shock (OR: 2.2; = 0.002) and hospitalization in the previous 90 days (OR: 2.3; = 0.003). Independent risk factors for sepsis due to ESBL+ bacteria were hospitalization in the previous 90 days (OR: 2.1; = 0.02) and stroke (OR: 2.1; = 0.04). A significantly higher mortality was detected among patients with vs. without MDR bacteria (40.2% vs. 23.1% respectively, = 0.001). Independent risk factors for mortality among patients with sepsis were coagulation dysfunction (OR: 3.2; = 0.03), septic shock (OR: 3.2; = 0.003), and isolation of a MDR bacteria (OR: 4.6; < 0.001).
In light of the prevalence and impact of MDR bacteria causing sepsis in patients coming from the community, physicians should consider ESBL coverage when starting an empiric antibiotic therapy in patients with specific risk factors, especially in the presence of septic shock.
尽管先前的研究表明社区中多重耐药（MDR）菌引起的感染患病率呈上升趋势，但关于脓毒症的具体数据仍很缺乏。我们旨在评估由MDR菌引起脓毒症患者的患病率、危险因素及预后情况。
对2011年1月至2015年12月期间连续入住意大利米兰综合医院且诊断为脓毒症的成年社区患者进行了一项观察性回顾性研究。主要研究结局为住院死亡率。
在518例患者中，88例（17%）分离出至少一种MDR菌。产超广谱β-内酰胺酶（ESBL+）菌是最常见的MDR菌（9.7%），其次是耐甲氧西林金黄色葡萄球菌（MRSA，3.9%）。MDR菌引起脓毒症的独立危险因素为感染性休克（比值比：2.2；P = 0.002）和过去90天内住院（比值比：2.3；P = 0.003）。ESBL+菌引起脓毒症的独立危险因素为过去90天内住院（比值比：2.1；P = 0.02）和中风（比值比：2.1；P = 0.04）。检测发现有MDR菌的患者死亡率显著高于无MDR菌的患者（分别为40.2%和23.1%，P = 0.001）。脓毒症患者死亡的独立危险因素为凝血功能障碍（比值比：3.2；P = 0.03）、感染性休克（比值比：3.2；P = 0.003）和分离出MDR菌（比值比：4.6；P < 0.001）。
鉴于社区患者中MDR菌引起脓毒症的患病率及其影响，医生在对有特定危险因素的患者，尤其是存在感染性休克的患者开始经验性抗生素治疗时，应考虑覆盖ESBL。
