Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Sevilla, Spain.
Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Sevilla, Spain.
Clin Microbiol Infect. 2021 Feb;27(2):283.e9-283.e16. doi: 10.1016/j.cmi.2020.05.015. Epub 2020 May 26.
During the last decade, some changes in the epidemiology of invasive infections have been reported; however, specific studies with patient-level data are scarce. The aim of this study was to describe and evaluate the epidemiologic changes in bloodstream infections (BSI) during the last decade in Andalucía, Spain.
Data from two prospective cohorts of BSI in adults with the same methodology performed 10 years apart in 11 hospitals (eight tertiary and three community) in Andalucía, Spain, were compared; the 2006-7 cohort study was performed between October 2006 and March 2007, and the 2016-17 cohort study was performed between October 2016 and March 2017. Population-based incidence rates were calculated and extrapolated for 1 year. Relative risk ratios were calculated between the 2 periods. Multivariate analyses were performed by logistic regression.
Overall, 1262 episodes of BSI were included, 563 (44.6%) in 2006-7 and 699 (55.3%) in 2016-17. Multivariate models selected the following changes in patients' features in 2016-17, after controlling for type of acquisition: higher age (odds ratio (OR) = 1.02; 95% confidence interval [CI] 1.01-1.03), lower urinary catheter (OR = 0.37; 95% CI, 0.26-0.48) and lower Pitt score (OR = 0.76; 95% CI, 0.71-0.82). Adjusted estimations considering patients' features and exposure to procedures showed a reduction in coagulase-negative staphylococci (OR = 0.47; 95% CI, 0.32-0.69), and an increase in Proteus spp. (OR = 3.12; 95% CI, 1.18-8.23) and Candida spp. (OR = 3.01; 95% CI, 1.03-8.86).
We found relevant epidemiologic changes in BSI in our area, including rates, frequency of acquisition types, changes in patient's profiles and aetiologic agents.
在过去的十年中，侵袭性感染的流行病学发生了一些变化；然而，具体的患者水平数据研究很少。本研究旨在描述和评估过去十年中西班牙安达卢西亚血流感染（BSI）的流行病学变化。
对西班牙安达卢西亚 11 家医院（8 家三级医院和 3 家社区医院）进行的两项前瞻性成人 BSI 队列研究的数据进行了比较；2006-7 年队列研究于 2006 年 10 月至 2007 年 3 月进行，2016-17 年队列研究于 2016 年 10 月至 2017 年 3 月进行。计算了基于人群的发病率，并进行了一年的外推。计算了两个时期的相对风险比。通过逻辑回归进行多变量分析。
共纳入 1262 例 BSI 病例，其中 563 例（44.6%）发生于 2006-7 年，699 例（55.3%）发生于 2016-17 年。多变量模型选择了 2016-17 年患者特征的以下变化，这些变化在控制了感染类型后仍然存在：更高的年龄（比值比（OR）=1.02；95%置信区间[CI] 1.01-1.03）、较低的导尿管使用率（OR=0.37；95%CI，0.26-0.48）和较低的 Pitt 评分（OR=0.76；95%CI，0.71-0.82）。考虑患者特征和暴露于程序的调整估计显示凝固酶阴性葡萄球菌的减少（OR=0.47；95%CI，0.32-0.69）和变形杆菌属（OR=3.12；95%CI，1.18-8.23）和念珠菌属（OR=3.01；95%CI，1.03-8.86）的增加。
我们发现我们地区的血流感染存在重要的流行病学变化，包括发病率、感染类型频率、患者特征和病原体的变化。
