606 例西班牙成人蜂窝织炎患者中与脓毒症发展相关的因素。
Factors associated with sepsis development in 606 Spanish adult patients with cellulitis.
机构信息
Infectious Diseases Unit, Hospital de Galdácano, Vizcaya, Spain.
Infectious Diseases Unit, Hospital de Cabueñes, Gijón, Spain.
出版信息
BMC Infect Dis. 2020 Mar 12;20(1):211. doi: 10.1186/s12879-020-4915-1.
BACKGROUND
Cellulitis, a frequent cause of admission of adult patients to medical wards, occasionally evolves to sepsis. In this study we analyze the factors related to sepsis development.
METHODS
Prospective and observational study of 606 adult patients with cellulitis admitted to several Spanish hospitals. Comorbidities, microbiological, clinical, lab, diagnostic, and treatment data were analyzed. Sepsis was diagnosed according to the criteria of the 2016 International Sepsis Definitions Conference. Multiple logistic regression modelling was performed to determine the variables independently associated with sepsis development.
RESULTS
Mean age was 63.4 years and 51.8% were men. Overall 65 (10.7%) patients developed sepsis, 7 (10.8%) of whom died, but only 4 (6.2%) due to cellulitis. Drawing of blood (P < 0.0001) or any (P < 0.0001) culture, and identification of the agent (P = 0.005) were more likely among patients with sepsis. These patients had also a longer duration of symptoms (P = 0.04), higher temperature (P = 0.03), more extensive cellulitis (P = 0.02), higher leukocyte (P < 0.0001) and neutrophil (P < 0.0001) counts, serum creatinine (P = 0.001), and CRP (P = 0.008) than patients without sepsis. Regarding therapy, patients with sepsis were more likely to undergo changes in the initial antimicrobial regimen (P < 0.0001), received more antimicrobials (P < 0.0001), received longer intravenous treatment (P = 0.03), and underwent surgery more commonly (P = 0.01) than patients without sepsis. Leukocyte counts (P = 0.002), serum creatinine (P = 0.003), drawing of blood cultures (P = 0.004), change of the initial antimicrobial regimen (P = 0.007) and length of cellulitis (P = 0.009) were independently associated with sepsis development in the multivariate analysis.
CONCLUSIONS
Increased blood leukocytes and serum creatinine, blood culture drawn, modification of the initial antimicrobial regimen, and maximum length of cellulitis were associated with sepsis in these patients.
背景
蜂窝织炎是导致成年患者入住内科病房的常见病因，偶尔会发展为败血症。本研究分析了与败血症发展相关的因素。
方法
对来自西班牙多家医院的 606 例成年蜂窝织炎患者进行前瞻性、观察性研究。分析合并症、微生物学、临床、实验室、诊断和治疗数据。根据 2016 年国际败血症定义会议的标准诊断败血症。采用多变量逻辑回归模型确定与败血症发展相关的独立变量。
结果
平均年龄为 63.4 岁，51.8%为男性。共有 65 例（10.7%）患者发生败血症，其中 7 例（10.8%）死亡，但仅 4 例（6.2%）死于蜂窝织炎。败血症患者更有可能进行血液（P<0.0001）或任何（P<0.0001）培养物的抽取，以及鉴定病原体（P=0.005）。这些患者的症状持续时间更长（P=0.04），体温更高（P=0.03），蜂窝织炎范围更广（P=0.02），白细胞（P<0.0001）和中性粒细胞（P<0.0001）计数更高，血清肌酐（P=0.001）和 CRP（P=0.008）更高。与无败血症患者相比，接受初始抗菌治疗方案改变（P<0.0001）、使用更多抗菌药物（P<0.0001）、静脉治疗时间更长（P=0.03）和更常接受手术治疗（P=0.01）的可能性更高。白细胞计数（P=0.002）、血清肌酐（P=0.003）、血液培养（P=0.004）、初始抗菌治疗方案改变（P=0.007）和蜂窝织炎长度（P=0.009）在多变量分析中与败血症的发生独立相关。
结论
白细胞和血清肌酐升高、血培养、初始抗菌方案改变以及蜂窝织炎最大长度与这些患者的败血症有关。
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