Goren Idan, Brom Adi, Yanai Henit, Dagan Amir, Segal Gad, Israel Ariel
Division of Gastroenterology, Rabin Medical Center * , Petah Tikva, Israel.
Internal Medicine T, Chaim Sheba Medical Center * , Tel-Hashomer, Ramat-Gan, Israel.
United European Gastroenterol J. 2020 Mar;8(2):195-203. doi: 10.1177/2050640619874524. Epub 2019 Sep 5.
Patients with inflammatory bowel disease might be at increased risk of invasive bacterial infections.
The objective of this study was to identify the rate of bacteremia in hospitalised patients with inflammatory bowel disease and risk factors.
An observational cohort of hospitalised patients with inflammatory bowel disease, aged 16-80 years, from 2008 to 2017 in a large tertiary hospital. Patients with Charlson comorbidity index of 2 or greater were excluded. Patients with one or more positive blood culture were reviewed. Logistic regression was used to evaluate risk factors for bacteremia.
Of 5522 admitted patients, only 1.3% had bacteremia (73/5522) (39, Crohn's disease; 25, ulcerative colitis; nine, unclassified inflammatory bowel disease). The most common pathogen was (19/73 patients). The mortality rate at 30 days of patients with bacteremia was 13.7% (10/73). Longer hospitalisations (mean length of stay (21.6 ± 31.0 vs. 6.4 ± 16.0 days; < 0.0001) and older age (mean age 47.5 ± 18.0 vs. 40.2 ± 15.4 years, < 0.0001)) were associated with an increased risk of bacteremia. In multivariate analysis, treatment with either anti-tumour necrosis factor α, purine analogues, steroids or amino salicylates was not associated with an increased risk of bacteremia. Risk was greatest among patients aged 65 years or older (relative risk 2.84, 95% confidence interval 1.6-4.8; = 0.0001) relative to those under 65 years.
Age over 65 years, but not inflammatory bowel disease-related medications, is associated with an increased risk of bacteremia in hospitalised patients with inflammatory bowel disease.
炎症性肠病患者发生侵袭性细菌感染的风险可能会增加。
本研究的目的是确定住院炎症性肠病患者的菌血症发生率及危险因素。
对2008年至2017年在一家大型三级医院住院的16至80岁炎症性肠病患者进行观察性队列研究。排除Charlson合并症指数为2或更高的患者。对血培养一项或多项呈阳性的患者进行回顾。采用逻辑回归评估菌血症的危险因素。
在5522例入院患者中，仅有1.3%发生菌血症（73/5522）（克罗恩病39例；溃疡性结肠炎25例；未分类的炎症性肠病9例）。最常见的病原体是……（73例患者中有19例）。菌血症患者30天的死亡率为13.7%（10/73）。住院时间较长（平均住院时间（21.6±31.0天与6.4±16.0天；P<0.0001））和年龄较大（平均年龄47.5±18.0岁与40.2±15.4岁，P<0.000）与菌血症风险增加相关。在多变量分析中，使用抗肿瘤坏死因子α、嘌呤类似物、类固醇或氨基水杨酸酯进行治疗与菌血症风险增加无关。65岁及以上患者的风险相对于65岁以下患者最高（相对风险2.84，95%置信区间1.6 - 4.8；P = 0.0001）。
65岁以上年龄，而非炎症性肠病相关药物，与住院炎症性肠病患者菌血症风险增加相关。
