Department of General Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
Department of General Medicine and Infectious Diseases, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama, 708-0841, Japan.
Infection. 2022 Oct;50(5):1233-1242. doi: 10.1007/s15010-022-01799-7. Epub 2022 Mar 17.
To clarify the clinical and microbial characteristics of polymicrobial bacteremia (PMB) to contribute to improvements in clinical diagnosis and effective early treatment.
This retrospective multicenter study used data from three acute-care hospitals in Okayama Prefecture, Japan, collected between January 2014 and March 2019. We reviewed the demographics, comorbidities, organisms isolated, infectious focus, and 30-day mortality of patients with PMB.
Of the 7233 positive blood cultures, 808 (11.2%) were positive for more than one organism. Of the patients with bacteremia, 507 (7.0%) had PMB, of whom 65.3% were male. Infectious foci were identified in 78.3% of the cases, of which intra-abdominal infections accounted for 47.1%. A combination of Gram-positive cocci (GPC) (chain form) and Gram-negative rods (GNR) accounted for 32.9% of the cases, and GPC/GNR and GNR/GNR patterns were significantly associated with intra-abdominal infections. The 30-day mortality rate of patients with PMB was 18.1%, with a median of 7.5 days from diagnosis to death. The mortality in patients with an infectious focus identified was significantly lower than that in patients with an unknown focus (16.3% vs. 24.5%; p = 0.031).
Intra-abdominal infections were the most common source of PMB, and were strongly associated with a Gram-staining combination pattern of GPC (chain form)/GNR. PMB cases with an unknown focus had a poorer prognosis, highlighting the importance of early diagnosis and appropriate treatment.
阐明多微生物菌血症（PMB）的临床和微生物特征，有助于改善临床诊断和有效早期治疗。
本回顾性多中心研究使用了日本冈山县三所急性护理医院在 2014 年 1 月至 2019 年 3 月期间收集的数据。我们回顾了 PMB 患者的人口统计学、合并症、分离出的病原体、感染焦点和 30 天死亡率。
在 7233 份阳性血培养中，808 份（11.2%）为一种以上病原体阳性。在菌血症患者中，507 例（7.0%）患有 PMB，其中 65.3%为男性。78.3%的病例确定了感染焦点，其中腹腔内感染占 47.1%。革兰阳性球菌（GPC）（链状）和革兰阴性杆菌（GNR）的组合占 32.9%，GPC/GNR 和 GNR/GNR 模式与腹腔内感染显著相关。PMB 患者的 30 天死亡率为 18.1%，从诊断到死亡的中位时间为 7.5 天。确定感染焦点的患者死亡率明显低于未确定感染焦点的患者（16.3%比 24.5%；p=0.031）。
腹腔内感染是 PMB 最常见的来源，与 GPC（链状）/GNR 的革兰氏染色组合模式密切相关。PMB 患者的焦点不明，预后较差，强调了早期诊断和适当治疗的重要性。
