Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
Clin Microbiol Infect. 2022 Jun;28(6):879.e9-879.e15. doi: 10.1016/j.cmi.2021.12.011. Epub 2021 Dec 18.
The effect of hospital-acquired bacteraemia on mortality is sparsely investigated. We investigated the incidence and hospital-acquired bacteraemia impact on mortality.
We conducted a 13-year population-based cohort study using the North Denmark Bacteraemia Research Database and Danish health registries. The population comprised all adult patients with a hospital admission lasting ≥48 hr. We used Poisson regression to estimate trends in incidence. The 30-day mortality of hospital-acquired bacteraemia was estimated using an illness-death multistate model with recovery using the population at risk of hospital-acquired bacteraemia as reference.
We identified 3588 episodes of hospital-acquired bacteraemia in 484 264 admissions. The incidence increased proportionally by 1.02 episodes yearly (95% CI 1.01-1.03) between 2006 and 2018. Hospital-acquired bacteraemia was associated with increased mortality (adjusted hazard ratio (aHR) 4.32, 95% CI 3.95-4.72), especially hospital-acquired bacteraemia with unknown source (aHR 6.42 (95% CI 5.67-7.26), "thoracic incl. pneumonia" (aHR 5.89, 95% CI 3.45-10.12) and abdominal source (aHR 4.33, 95% CI 3.27-5.74). The relative impact on mortality diminished with age (aHR 5.66, 95% CI 2.00-16.01 in 18-40 years old vs. 3.69, 95% CI 3.14-4.32 in 81-105 years old) and comorbidity (aHR 5.75, 95% CI 4.45-7.42 in low vs. 3.55, 95% CI 3.16-3.98 in high comorbidity), and was higher in elective admissions (aHR 9.09, 95% CI 7.14-11.57 vs. aHR of 4.03, 95% CI 3.67-4.42).
Hospital-acquired bacteraemia is associated with high mortality, especially when the source is unknown or originating from the thoracic cavity.
医院获得性菌血症对死亡率的影响研究较少。本研究旨在调查发病率和医院获得性菌血症对死亡率的影响。
我们进行了一项基于人群的 13 年队列研究，使用了丹麦北日德兰菌血症研究数据库和丹麦健康登记处。该人群包括所有住院时间≥48 小时的成年患者。我们使用泊松回归估计发病率趋势。使用疾病-死亡多状态模型估计医院获得性菌血症的 30 天死亡率，以具有医院获得性菌血症风险的人群为参考，恢复使用。
我们在 484264 例住院患者中发现了 3588 例医院获得性菌血症发作。2006 年至 2018 年，发病率每年按比例增加 1.02 例（95%置信区间 1.01-1.03）。医院获得性菌血症与死亡率增加相关（校正后的危险比（aHR）4.32，95%置信区间 3.95-4.72），尤其是不明来源的医院获得性菌血症（aHR 6.42（95%置信区间 5.67-7.26），“胸部包括肺炎”（aHR 5.89，95%置信区间 3.45-10.12）和腹部来源（aHR 4.33，95%置信区间 3.27-5.74）。随着年龄的增长（18-40 岁年龄组的 aHR 为 5.66（95%置信区间 2.00-16.01），81-105 岁年龄组的 aHR 为 3.69（95%置信区间 3.14-4.32））和合并症（低合并症的 aHR 为 5.75（95%置信区间 4.45-7.42），高合并症的 aHR 为 3.55（95%置信区间 3.16-3.98）），死亡率的相对影响降低，选择性入院的影响更高（aHR 9.09，95%置信区间 7.14-11.57 vs. aHR 4.03，95%置信区间 3.67-4.42）。
医院获得性菌血症与高死亡率相关，尤其是当来源不明或源自胸腔时。
