Departments of Internal Medicine H.
MDClone Ltd, Beer Sheva, Israel.
J Clin Gastroenterol. 2022 Jan 1;56(1):e58-e63. doi: 10.1097/MCG.0000000000001476.
The risk for bacteremia following endoscopic procedures varies among studies. A low neutrophil count is considered as a risk factor.
To assess risk factors for bacteremia following endoscopic procedures, focusing on neutropenia.
This was a retrospective analysis of all inpatients undergoing endoscopic procedures between 2005 and 2018 with neutrophil count taken within 72 hours before the procedure in a tertiary center in Israel. The primary outcome was positive blood culture within 48 hours following the procedure of bacteria that was not cultured before. Risk factors for bacteremia were assessed and multivariate logistic regression models were built. In neutropenic patients, comparator groups were used to assess the risk related to the procedure and neutropenia.
Of 13,168 patients included, postprocedural bacteremia was recorded in 103 (0.8%). Neutropenia, low albumin level, male gender, older age, preprocedure fever, and admitting department were associated with increased risk for bacteremia in both univariate and multivariate analyses. A multivariate model including these factors was found to be predictive of bacteremia (area under the curve 0.82; 95% confidence interval, 0.78-0.88). In neutropenic patients, the risk of postendoscopic bacteremia (4.2%) was not significantly different compared with neutropenic patients undergoing bronchoscopy (1.8%, P=0.14) or from the rate of bacteremia-to-neutropenic episodes ("background risk") in neutropenic patients in general (6.3%, P=0.33).
Postendoscopic bacteremia is a rare event among inpatients. Although neutropenia was found to be a risk factor for bacteremia, it was not higher than the background risk in these patients. Models highly predictive of bacteremia were developed and should be validated.
内镜检查后发生菌血症的风险因研究而异。中性粒细胞计数低被认为是一个危险因素。
评估内镜检查后发生菌血症的危险因素，重点关注中性粒细胞减少症。
这是对以色列一家三级中心 2005 年至 2018 年间所有接受内镜检查的住院患者进行的回顾性分析，在检查前 72 小时内采集了中性粒细胞计数。主要结局是在检查后 48 小时内从血培养中获得阳性的细菌，而这些细菌在检查前未被培养。评估了菌血症的危险因素，并建立了多变量逻辑回归模型。在中性粒细胞减少症患者中，采用对照组评估与检查和中性粒细胞减少症相关的风险。
在纳入的 13168 例患者中，有 103 例（0.8%）记录到术后菌血症。中性粒细胞减少症、低白蛋白水平、男性、年龄较大、术前发热和入院科室在单变量和多变量分析中均与菌血症风险增加相关。包括这些因素的多变量模型被发现对菌血症具有预测性（曲线下面积 0.82；95%置信区间，0.78-0.88）。在中性粒细胞减少症患者中，与接受支气管镜检查的中性粒细胞减少症患者（1.8%，P=0.14）或一般中性粒细胞减少症患者的菌血症-中性粒细胞减少症发作率（“背景风险”）相比，内镜检查后发生菌血症的风险（4.2%）并无显著差异（P=0.33）。
住院患者内镜检查后发生菌血症是一种罕见事件。虽然中性粒细胞减少症被认为是菌血症的危险因素，但在这些患者中，其风险并不高于背景风险。已经开发出高度预测菌血症的模型，应进行验证。
