多药耐药菌可预测坦桑尼亚三级医疗机构血流感染患者的死亡率。
Multi-drug resistant bacteria predict mortality in bloodstream infection in a tertiary setting in Tanzania.
机构信息
Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Central pathology laboratory, Muhimbili National Hospital, Dar es Salaam, Tanzania.
出版信息
PLoS One. 2020 Mar 4;15(3):e0220424. doi: 10.1371/journal.pone.0220424. eCollection 2020.
BACKGROUND
Bloodstream infections (BSI) are serious and life-threatening, associated with high mortality and morbidity. In resource-limited settings, there is a paucity of data on predictors of outcome in patients with BSI. This study aimed at examining the predictors of mortality in patients with BSI as well as bacteria causing BSI.
METHODS AND MATERIALS
This was a cross-sectional study conducted at Muhimbili National Hospital between April and May 2018. Blood culture results from all inpatients at the clinical microbiology laboratory were recorded and clinical information was retrieved retrospectively from the files. Bacteria from positive blood culture were identified and antimicrobial susceptibility was performed.
RESULTS
The overall prevalence of BSI was, 46/402 (11.4% 95% CI 8.6-15), with a case fatality rate of 37%. There was a significantly high rate of BSI in patients who had died (19.5%) compared to those who survived (9.2%) p = 0.008. Gram-negative bacteria (74%) were the common cause of BSI, with a predominance of Enterobacteriaceae (22), followed by Pseudomonas aeruginosa (11). The majority of bacteria (70.5%) isolated from patients with BSI were Multi-drug resistant (MDR). Forty-six percent of Pseudomonas aeruginosa were resistant to meropenem while 68% (15/22) of Enterobacteriaceae were extended-spectrum β lactamase producers. Carbapenemase production was detected in 27% (3/11) of Pseudomonas aeruginosa and one Proteus mirabilis. Forty percent of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus. Positive blood culture (aOR 2.24, 95%CI 1.12-4.47, p 0.02) and admission to the intensive care unit (aOR 3.88, 95%CI 1.60-9.41, p = 0.003) were independent factors for mortality in suspected BSI. Isolation of MDR bacteria was an independent predictor for mortality in confirmed BSI (aOR 15.62, 95%CI 1.24-161.38, p = 0.02).
CONCLUSION
The prevalence of BSI was 11.4%, with the majority of bacteria in BSI were MDR. Positive blood culture, admission to the ICU and MDR were predictors for mortality.
背景
血流感染（BSI）是严重且危及生命的，与高死亡率和发病率相关。在资源有限的环境中，BSI 患者预后的预测因素数据很少。本研究旨在研究 BSI 患者及引起 BSI 的细菌的死亡预测因素。
方法和材料
这是 2018 年 4 月至 5 月在穆希比利国家医院进行的一项横断面研究。记录了临床微生物学实验室所有住院患者的血培养结果，并从档案中回顾性检索临床信息。从阳性血培养中分离出细菌，并进行了药敏试验。
结果
BSI 的总患病率为 46/402（11.4%95%CI8.6-15），病死率为 37%。与存活者（9.2%）相比，死亡者（19.5%）BSI 发生率显著较高，p=0.008。革兰氏阴性菌（74%）是 BSI 的常见原因，肠杆菌科（22%）占主导地位，其次是铜绿假单胞菌（11%）。从 BSI 患者中分离出的大多数细菌（70.5%）为多药耐药菌（MDR）。46%的铜绿假单胞菌对美罗培南耐药，68%（15/22）的肠杆菌科为扩展谱β内酰胺酶产生菌。检测到 27%（3/11）的铜绿假单胞菌和 1 株奇异变形杆菌产碳青霉烯酶。40%的金黄色葡萄球菌为耐甲氧西林金黄色葡萄球菌。阳性血培养（优势比 2.24，95%CI1.12-4.47，p=0.02）和入住重症监护病房（优势比 3.88，95%CI1.60-9.41，p=0.003）是疑似 BSI 患者死亡的独立因素。MDR 细菌的分离是确诊 BSI 患者死亡的独立预测因素（优势比 15.62，95%CI1.24-161.38，p=0.02）。
结论
BSI 的患病率为 11.4%，BSI 中的大多数细菌为 MDR。阳性血培养、入住 ICU 和 MDR 是死亡的预测因素。
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