Department of Clinical Microbiology and Immunology, School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, China.
Department of Clinical Microbiology and Immunology, School of Clinical Laboratory Science, Guizhou Medical University, Guiyang, China; Department of Microbiology and Immunology, Guizhou Medical University Affiliated Hospital, Guiyang, China.
Arch Gerontol Geriatr. 2021 Mar-Apr;93:104315. doi: 10.1016/j.archger.2020.104315. Epub 2020 Nov 28.
To investigate risk factors for Escherichia coli (E. coli) bloodstream infection (BSI) in older patients and the diagnostic accuracy of laboratory parameters.
The electronic medical records of patients aged 60 years and above who were admitted with a serious condition were extracted. Propensity score matching (PSM) was used to ensure that the included patients had similar baseline clinical features. Multiple regression analysis was used to identify risk factors for E. coli BSI and extended-spectrum β-lactamase (ESBL)-producing E. coli BSI. Receiver operating characteristic (ROC) curve analysis was performed to determine the diagnostic utility of relevant laboratory indicators.
After PSM, 508 patients were included: 254 patients with E. coli BSI and 254 control patients. Bile duct stone (adjusted odds ratio [aOR] 5.131), kidney stone (aOR 3.678), and urinary system infection (aOR 3.173) were independent risk factors for E. coli BSI. Prior exposure to cephems (aOR 3.782) and drainage tube placement (aOR 2.572) were independent risk factors for ESBL-producing E. coli BSI. Serum procalcitonin (PCT) yielded the highest area under the curve (0.783) and the best cut-off value (1.3 ng/ml).
Bile duct stone, kidney stone, and urinary system infection must be detected and treated early, in order to prevent E. coli BSI in older patients. Further, administration of cephems and invasive procedures must be undertaken with caution, in order to reduce the risk of BSI with ESBL-producing E. coli. Finally, serum PCT level has potential as diagnostic marker for E. coli BSI in older individuals.
研究老年患者大肠埃希菌（E. coli）血流感染（BSI）的危险因素和实验室参数的诊断准确性。
提取电子病历中年龄在 60 岁及以上且病情严重的患者。采用倾向评分匹配（PSM）确保纳入患者具有相似的基线临床特征。采用多元回归分析确定 E. coli BSI 和产超广谱β-内酰胺酶（ESBL）大肠埃希菌 BSI 的危险因素。通过接受者操作特征（ROC）曲线分析来确定相关实验室指标的诊断效用。
PSM 后共纳入 508 例患者：大肠埃希菌 BSI 患者 254 例，对照组患者 254 例。胆管结石（校正优势比 [aOR] 5.131）、肾结石（aOR 3.678）和泌尿系统感染（aOR 3.173）是大肠埃希菌 BSI 的独立危险因素。先前使用头孢菌素（aOR 3.782）和引流管放置（aOR 2.572）是产 ESBL 大肠埃希菌 BSI 的独立危险因素。血清降钙素原（PCT）的曲线下面积（AUC）最高（0.783），最佳截断值（1.3 ng/ml）。
老年患者必须早期检测和治疗胆管结石、肾结石和泌尿系统感染，以预防大肠埃希菌 BSI。此外，应谨慎使用头孢菌素和有创操作，以降低产 ESBL 大肠埃希菌 BSI 的风险。最后，血清 PCT 水平可能是老年个体大肠埃希菌 BSI 的潜在诊断标志物。
