Department of Microbiology and Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospital Virgen de las Nieves, Granada, Spain.
Department of Medicine (University of Granada), Granada, Spain.
Anaerobe. 2020 Aug;64:102219. doi: 10.1016/j.anaerobe.2020.102219. Epub 2020 Jun 10.
The objectives of this study were to report those variables which are readily identifiable at the bedside and that are able to predict mortality in patients with bacteraemia caused by anaerobes. Patients with clinically significant anaerobic bacteraemias detected between January 2016 and December 2019 in a tertiary hospital in Granada (Spain) were retrospectively included. Species identification was performed by MALDI-TOF MS and/or molecular methods. Finally, 136 cases of anaerobic bacteraemia were included, being the most frequent anaerobes Bacteroides (45.5%; n = 62), Clostridium (24.2%, n = 33), and Gram-positive anaerobic cocci (16.1%, n = 22). Crude mortality was 25.7%, corresponding to 35 patients who died, with 82.8% of deaths directly attributable to bacteraemia. A multivariable logistic regression model with non-parametric bootstrap estimation identified three variables that were independently and significantly associated with an increased risk of death: 1) hospitalization in the intensive care unit; 2) septic shock; and 3) presence of any kind of cancer. These variables were as recorded at the time that the first positive blood culture was obtained. An index score, obtained from these variables, was calculated and divided patients into two groups with increasing likelihood of mortality resulting from anaerobic bacteraemia. The sensitivity and specificity of a prediction of death based on this model were 65.2% and 97%, respectively.
本研究的目的是报告那些在床边易于识别且能够预测厌氧菌引起菌血症患者死亡率的变量。回顾性纳入 2016 年 1 月至 2019 年 12 月在西班牙格拉纳达一家三级医院检测到具有临床意义的厌氧菌菌血症的患者。通过 MALDI-TOF MS 和/或分子方法进行种属鉴定。最终纳入 136 例厌氧菌菌血症,最常见的厌氧菌为拟杆菌(45.5%,n=62)、梭菌(24.2%,n=33)和革兰阳性厌氧球菌(16.1%,n=22)。粗死亡率为 25.7%,对应 35 例死亡患者,其中 82.8%的死亡直接归因于菌血症。使用非参数 bootstrap 估计的多变量逻辑回归模型确定了三个与死亡风险增加独立且显著相关的变量:1)入住重症监护病房;2)感染性休克;3)存在任何类型的癌症。这些变量是在获得第一次阳性血培养时记录的。从这些变量中计算出一个指数评分,并将患者分为两组,厌氧菌菌血症导致死亡率增加的可能性逐渐增加。该模型预测死亡的灵敏度和特异性分别为 65.2%和 97%。