Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
PLoS Negl Trop Dis. 2021 Sep 3;15(9):e0009704. doi: 10.1371/journal.pntd.0009704. eCollection 2021 Sep.
Community acquired bacteremia (CAB) is a common cause of sepsis in low and middle-income countries (LMICs). However, knowledge about factors associated with outcomes of CAB in LMICs is limited.
METHODOLOGY/PRINCIPAL FINDINGS: A prospective observational study (Ubon-sepsis) of adults admitted to a referral hospital with community-acquired infection in Northeastern Thailand was conducted between March 1, 2013 and February 1, 2017. In the present analysis, patients with a blood culture collected within 24 hours of admission that was positive for one of the three most common pathogens were studied. Clinical features, management, and outcomes of patients with each cause of CAB were compared. Of 3,806 patients presenting with community-acquired sepsis, 155, 131 and 37 patients had a blood culture positive for Escherichia coli, Burkholderia pseudomallei and Staphylococcus aureus, respectively. Of these 323 CAB patients, 284 (89%) were transferred from other hospitals. 28-day mortality was highest in patients with B. pseudomallei bactaeremia (66%), followed by those with S. aureus bacteraemia (43%) and E. coli (19%) bacteraemia. In the multivariable Cox proportional hazards model adjusted for age, sex, transfer from another hospital, empirical antibiotics prior to or during the transfer, and presence of organ dysfunction on admission, B. pseudomallei (aHR 3.78; 95%CI 2.31-6.21) and S. aureus (aHR 2.72; 95%CI 1.40-5.28) bacteraemias were associated with higher mortality compared to E. coli bacteraemia. Receiving empirical antibiotics recommended for CAB caused by the etiologic organism prior to or during transfer was associated with survival (aHR 0.58; 95%CI 0.38-0.88).
CONCLUSIONS/SIGNIFICANCE: Mortality of patients with CAB caused by B. pseudomallei was higher than those caused by S. aureus and E. coli, even after adjusting for presence of organ dysfunction on admission and effectiveness of empirical antibiotics received. Improving algorithms or rapid diagnostic tests to guide early empirical antibiotic may be key to improving CAB outcomes in LMICs.
社区获得性菌血症（CAB）是中低收入国家（LMICs）败血症的常见病因。然而，关于 LMICs 中与 CAB 结果相关的因素的知识有限。
方法/主要发现：2013 年 3 月 1 日至 2017 年 2 月 1 日，在泰国东北部的一家转诊医院对患有社区获得性感染的成年人进行了一项前瞻性观察性研究（乌汶败血症）。在本分析中，研究了在入院 24 小时内采集的血液培养物呈三种最常见病原体之一阳性的患者。比较了每位 CAB 患者的临床特征、治疗方法和结局。在 3806 例患有社区获得性败血症的患者中，155 例、131 例和 37 例血培养阳性分别为大肠杆菌、类鼻疽伯克霍尔德菌和金黄色葡萄球菌。在这 323 例 CAB 患者中，有 284 例（89%）从其他医院转来。28 天死亡率在类鼻疽伯克霍尔德菌菌血症患者中最高（66%），其次是金黄色葡萄球菌菌血症（43%）和大肠杆菌菌血症（19%）。在调整年龄、性别、从其他医院转来、转来前或转来时经验性抗生素以及入院时器官功能障碍存在的多变量 Cox 比例风险模型中，类鼻疽伯克霍尔德菌（aHR 3.78；95%CI 2.31-6.21）和金黄色葡萄球菌（aHR 2.72；95%CI 1.40-5.28）菌血症与大肠杆菌菌血症相比，死亡率更高。在转来前或转来时接受针对病因生物体引起的 CAB 的经验性抗生素治疗与生存相关（aHR 0.58；95%CI 0.38-0.88）。
结论/意义：即使在调整了入院时器官功能障碍的存在和经验性抗生素的有效性后，类鼻疽伯克霍尔德菌引起的 CAB 患者的死亡率仍高于金黄色葡萄球菌和大肠杆菌引起的死亡率。改进算法或快速诊断试验以指导早期经验性抗生素治疗可能是改善 LMICs 中 CAB 结果的关键。
