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金黄色葡萄球菌菌血症患者床边快速序贯器官衰竭评估(qSOFA)与全身炎症反应综合征(SIRS)量表的比较

Comparison of quick SOFA and SIRS scales at the bedside of patients with Staphylococcus aureus bacteremia.

作者信息

García Óscar, Álvarez Tatiana, Granados Santiago, Garzón Vanessa, González Santiago

机构信息

Grupo de Investigación en Medicina interna, Universidad Tecnológica de Pereira, Pereira, Colombia.

出版信息

Biomedica. 2020 May 1;40(Supl. 1):125-131. doi: 10.7705/biomedica.4943.

Abstract

Introduction: One of the primary causes of community-acquired bacteremia also associated with nosocomial infections is Staphylococcus aureus, which is responsible for a high percentage of complications leading to high morbidity and mortality rates. The systemic inflammatory response syndrome (SIRS) criteria have been traditionally used to evaluate the presence of sepsis; however, recent evidence questions its predictive value due to its low sensitivity and specificity. In 2016, new criteria for sepsis were published and a new tool emerged, quick SOFA (qSOFA), for the rapid evaluation of infection in emergency services. Objective: To compare the qSOFA and SRIS tools for the prediction of bacteremia caused by S. aureus. Materials and methods: We conducted an observational study in patients with S. aureus bacteremia to evaluate their phenotypic resistance patterns, some special features (sociodemographic characteristics, clinical and paraclinical values), complications, and mortality. The results of the qSOFA and SIRS scales were analyzed to identify which of them could better predict the presence of S. aureus bacteremia. Results: Twenty-six bacteremic patients were identified. Staphylococcus aureus was the second most frequently isolated bacteria. The results evidenced a mortality rate of 50% (13 cases) and a prevalence of 30% of MRSA. For the clinical scores evaluated, the qSOFA scale was positive in 30.8% of the patients, and the SIRS scale, in 92.3%. Discussion: The mortality rate for the population under study was high and the qSOFA tool had a lower diagnostic yield compared to the classic criteria for SIRS.

摘要

引言

社区获得性菌血症的主要病因之一,同时也与医院感染相关,是金黄色葡萄球菌,它导致了高比例的并发症,进而导致高发病率和死亡率。传统上,全身炎症反应综合征(SIRS)标准被用于评估脓毒症的存在;然而,最近的证据因其低敏感性和特异性而对其预测价值提出质疑。2016年,脓毒症的新标准发布,一种新工具——快速序贯器官衰竭评估(qSOFA)出现,用于急诊服务中感染的快速评估。目的:比较qSOFA和SRIS工具对金黄色葡萄球菌所致菌血症的预测能力。材料与方法:我们对金黄色葡萄球菌菌血症患者进行了一项观察性研究,以评估其表型耐药模式、一些特殊特征(社会人口统计学特征、临床和辅助检查值)、并发症及死亡率。分析qSOFA和SIRS量表的结果,以确定哪一种能更好地预测金黄色葡萄球菌菌血症的存在。结果:共识别出26例菌血症患者。金黄色葡萄球菌是第二常见的分离细菌。结果显示死亡率为50%(13例),耐甲氧西林金黄色葡萄球菌(MRSA)的患病率为30%。对于所评估的临床评分,qSOFA量表在30.8%的患者中呈阳性,而SIRS量表在92.3%的患者中呈阳性。讨论:所研究人群的死亡率较高,与经典的SIRS标准相比,qSOFA工具的诊断率较低。

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