Paquette Katryn, Sweet David, Stenstrom Robert, Stabler Sarah N, Lawandi Alexander, Akhter Murtaza, Davidson Adam C, Gavric Marko, Jinah Rehman, Saeed Zahid, Demir Koray, Sangsari Sassan, Huang Kelly, Mahpour Amirali, Shamatutu Chris, Caya Chelsea, Troquet Jean-Marc, Clark Greg, Wong Titus, Yansouni Cedric P, Cheng Matthew P
Division of Neonatology, Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada.
Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
Open Forum Infect Dis. 2021 Jun 17;8(7):ofab321. doi: 10.1093/ofid/ofab321. eCollection 2021 Jul.
Sepsis is a leading cause of morbidity, mortality, and health care costs worldwide.
We conducted a multicenter, prospective cohort study evaluating the yield of blood cultures drawn before and after empiric antimicrobial administration among adults presenting to the emergency department with severe manifestations of sepsis. Enrolled patients who had the requisite blood cultures drawn were followed for 90 days. We explored the independent association between blood culture positivity and its time to positivity in relation to 90-day mortality.
Three hundred twenty-five participants were enrolled; 90-day mortality among the 315 subjects followed up was 25.4% (80/315). Mortality was associated with age (mean age [standard deviation] in those who died was 72.5 [15.8] compared with 62.9 [17.7] years among survivors; < .0001), greater Charlson Comorbidity Index (2 [interquartile range {IQR}, 1-3] vs 1 [IQR, 0-3]; = .008), dementia (13/80 [16.2%] vs 18/235 [7.7%]; = .03), cancer (27/80 [33.8%] vs 47/235 [20.0%]; = .015), positive quick Sequential Organ Failure Assessment score (57/80 [71.2%] vs 129/235 [54.9%]; = .009), and normal white blood cell count (25/80 [31.2%] vs 42/235 [17.9%]; = .02). The presence of bacteremia, persistent bacteremia after antimicrobial infusion, and shorter time to blood culture positivity were not associated with mortality. Neither the source of infection nor pathogen affected mortality.
Although severe sepsis is an inflammatory condition triggered by infection, its 90-day survival is not influenced by blood culture positivity nor its time to positivity.
NCT01867905.
脓毒症是全球发病、死亡及医疗费用的主要原因。
我们开展了一项多中心前瞻性队列研究，评估在急诊科就诊的有严重脓毒症表现的成年人中，经验性使用抗菌药物前后采集的血培养结果的阳性率。对纳入并进行了必要血培养的患者随访90天。我们探讨了血培养阳性及其阳性时间与90天死亡率之间的独立关联。
共纳入325名参与者；315名接受随访的受试者90天死亡率为25.4%（80/315）。死亡率与年龄相关（死亡者的平均年龄[标准差]为72.5[15.8]岁，而幸存者为62.9[1,7.7]岁；P<0.0001）、较高的Charlson合并症指数（2[四分位间距{IQR}，1 - 3] vs 1[IQR，0 - 3]；P = 0.008）、痴呆（13/80[16.2%] vs 18/235[7.7%]；P = 0.03）、癌症（27/80[33.8%] vs 47/235[20.0%]；P = 0.015）、快速序贯器官衰竭评估评分阳性（57/80[71.2%] vs 129/235[54.9%]；P = 0.009）以及白细胞计数正常（25/80[31.2%] vs 42/235[17.9%]；P = 0.02）有关。菌血症的存在、抗菌药物输注后持续菌血症以及血培养阳性时间较短与死亡率无关。感染源和病原体均不影响死亡率。
尽管严重脓毒症是由感染引发的炎症性疾病，但其90天生存率不受血培养阳性及其阳性时间的影响。
NCT01867905。
