Jeon Minji, Huh Kyungmin, Ko Jae-Hoon, Cho Sun Young, Huh Hee Jae, Lee Nam Yong, Kang Cheol-In, Chung Doo Ryeon, Peck Kyong Ran
Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, Republic of Korea.
Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Republic of Korea.
Open Forum Infect Dis. 2021 Jul 20;8(8):ofab390. doi: 10.1093/ofid/ofab390. eCollection 2021 Aug.
The difference in clinical outcomes between (formerly ) bacteremia (KAB) and complex bacteremia (ECB) is controversial.
We compared the clinical outcomes of patients with KAB and ECB and examined the risk factors associated with mortality. We conducted a retrospective case-control study of hospitalized patients with monobacterial KAB and ECB between January 2011 and June 2020. The primary outcome measure was 30-day all-cause mortality. Multiple logistic regression and propensity-score (PS) matching were used to identify independent risk factors for mortality. The models included demographic characteristics, comorbidities, recent healthcare contact, patient status at the onset of bacteremia, and severity of infection as covariates.
A total of 282 patients with KAB or ECB were included, among whom 194 patients were selected after PS matching. The 30-day all-cause mortality rate was higher in the ECB group than in the KAB group (24.1% vs 10.6%, = .003). In a multivariable model, ECB was an independent risk factor for 30-day mortality in both overall and PS-matched cohorts (adjusted odds ratio, 3.528; 95% confidence interval, 1.614-7.714; = .002). Stay in the intensive care unit at the onset of bacteremia and higher Pitt bacteremia score were found to be independent risk factors for 30-day mortality.
In our study, mortality was significantly higher in patients with ECB than in those with KAB. Further studies are warranted to clarify the virulence mechanisms of complex.
（原称）肺炎克雷伯菌菌血症（KAB）和复杂菌血症（ECB）的临床结局差异存在争议。
我们比较了KAB和ECB患者的临床结局，并检查了与死亡率相关的危险因素。我们对2011年1月至2020年6月期间住院的单菌血症KAB和ECB患者进行了一项回顾性病例对照研究。主要结局指标是30天全因死亡率。采用多因素逻辑回归和倾向评分（PS）匹配来确定死亡率的独立危险因素。模型纳入人口统计学特征、合并症、近期医疗接触、菌血症发作时的患者状态以及感染严重程度作为协变量。
共纳入282例KAB或ECB患者，其中194例患者经PS匹配后入选。ECB组的30天全因死亡率高于KAB组（24.1%对10.6%，P = 0.003）。在多变量模型中，ECB在总体队列和PS匹配队列中均是30天死亡率的独立危险因素（调整后的比值比为3.528；95%置信区间为1.614 - 7.714；P = 0.002）。菌血症发作时入住重症监护病房以及较高的皮特菌血症评分被发现是30天死亡率的独立危险因素。
在我们的研究中，ECB患者的死亡率显著高于KAB患者。有必要进一步研究以阐明复杂菌血症的毒力机制。
