与血培养污染相关的危险因素和临床结局。

Risk factors and clinical outcomes associated with blood culture contamination.

机构信息

College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Mercy Hospital, Fort Smith, Arkansas.

出版信息

Infect Control Hosp Epidemiol. 2022 Mar;43(3):291-297. doi: 10.1017/ice.2021.111. Epub 2021 Apr 26.

DOI:10.1017/ice.2021.111

PMID:33896442

Abstract

OBJECTIVE

To determine patient-specific risk factors and clinical outcomes associated with contaminated blood cultures.

DESIGN

A single-center, retrospective case-control risk factor and clinical outcome analysis performed on inpatients with blood cultures collected in the emergency department, 2014-2018. Patients with contaminated blood cultures (cases) were compared to patients with negative blood cultures (controls).

SETTING

A 509-bed tertiary-care university hospital.

METHODS

Risk factors independently associated with blood-culture contamination were determined using multivariable logistic regression. The impacts of contamination on clinical outcomes were assessed using linear regression, logistic regression, and generalized linear model with γ log link.

RESULTS

Of 13,782 blood cultures, 1,504 (10.9%) true positives were excluded, leaving 1,012 (7.3%) cases and 11,266 (81.7%) controls. The following factors were independently associated with blood-culture contamination: increasing age (adjusted odds ratio [aOR], 1.01; 95% confidence interval [CI], 1.01-1.01), black race (aOR, 1.32; 95% CI, 1.15-1.51), increased body mass index (BMI; aOR, 1.01; 95% CI, 1.00-1.02), chronic obstructive pulmonary disease (aOR, 1.16; 95% CI, 1.02-1.33), paralysis (aOR 1.64; 95% CI, 1.26-2.14) and sepsis plus shock (aOR, 1.26; 95% CI, 1.07-1.49). After controlling for age, race, BMI, and sepsis, blood-culture contamination increased length of stay (LOS; β = 1.24 ± 0.24; P < .0001), length of antibiotic treatment (LOT; β = 1.01 ± 0.20; P < .001), hospital charges (β = 0.22 ± 0.03; P < .0001), acute kidney injury (AKI; aOR, 1.60; 95% CI, 1.40-1.83), echocardiogram orders (aOR, 1.51; 95% CI, 1.30-1.75) and in-hospital mortality (aOR, 1.69; 95% CI, 1.31-2.16).

CONCLUSIONS

These unique risk factors identify high-risk individuals for blood-culture contamination. After controlling for confounders, contamination significantly increased LOS, LOT, hospital charges, AKI, echocardiograms, and in-hospital mortality.

摘要

目的

确定与污染血培养相关的患者特异性危险因素和临床结局。

设计

在 2014 年至 2018 年间，对在急诊采集的血培养住院患者进行了单中心、回顾性病例对照危险因素和临床结局分析。将污染血培养的患者（病例）与阴性血培养的患者（对照）进行比较。

地点

一家拥有 509 张床位的三级保健大学医院。

方法

使用多变量逻辑回归确定与血培养污染独立相关的危险因素。使用线性回归、逻辑回归和具有γ对数链接的广义线性模型评估污染对临床结局的影响。

结果

在 13782 份血培养中，排除了 1504 份（10.9%）真阳性血培养，留下 1012 份（7.3%）病例和 11266 份（81.7%）对照。以下因素与血培养污染独立相关：年龄增加（调整后的优势比[aOR]，1.01；95%置信区间[CI]，1.01-1.01）、黑种人（aOR，1.32；95%CI，1.15-1.51）、体重指数（BMI）增加（aOR，1.01；95%CI，1.00-1.02）、慢性阻塞性肺疾病（aOR，1.16；95%CI，1.02-1.33）、瘫痪（aOR 1.64；95%CI，1.26-2.14）和脓毒症伴休克（aOR，1.26；95%CI，1.07-1.49）。在控制年龄、种族、BMI 和脓毒症后，血培养污染增加了住院时间（LOS；β=1.24±0.24；P<0.0001）、抗生素治疗时间（LOT；β=1.01±0.20；P<0.001）、医院费用（β=0.22±0.03；P<0.0001）、急性肾损伤（AKI；aOR，1.60；95%CI，1.40-1.83）、超声心动图检查（aOR，1.51；95%CI，1.30-1.75）和院内死亡率（aOR，1.69；95%CI，1.31-2.16）。