Isler Burcu, Paterson David L, Harris Patrick N A, Ling Weiping, Edwards Felicity, Rickard Claire M, Kidd Timothy J, Gassiep Ian, Laupland Kevin B
UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, RBWH Campus, Brisbane 4029, Australia.
Infection Management Services, Princess Alexandra Hospital, Brisbane 4102, Australia.
Microorganisms. 2022 Jul 18;10(7):1449. doi: 10.3390/microorganisms10071449.
Case reports and small series indicate that species bloodstream infection (BSI) is most commonly a complication of hospitalization among patients with chronic lung disease. The aim of the present study was to determine the incidence, risk factors, and outcomes of sp. BSI in an Australian population.
Retrospective, laboratory-based surveillance was conducted in Queensland, Australia (population ≈ 5 million) during 2000-2019. Clinical and outcome data were obtained by linkage to state hospital admissions and vital statistics databases. BSI diagnosed within the community or within the first two calendar days of stay in hospital were classified as community-onset. Community-onset BSIs were grouped into community-associated and healthcare-associated.
During more than 86 million person-years of surveillance, 210 incidents of sp. BSI occurred among 195 individuals for an overall age-and sex-standardized annual incidence of 2.6 per million residents. Older individuals and males were at highest risk (2.9 vs. 2.0 per million, IRR for males 1.5; 95% CI, 1.1-1.9; = 0.008). Most (153; 73%) cases were of community-onset of which 100 (48%) and 53 (25%) were healthcare- and community-associated, respectively. An increasing proportion of community-onset cases were observed during twenty years of surveillance. Underlying medical illnesses were common with median (interquartile range) Charlson Comorbidity Index (CCI) scores of 3 (1-5). CCI scores of 0, 1, 2, and 3+ were observed in 37 (18%), 27 (13%), 40 (19%), and 105 (50%) of cases, respectively. All but one of the cases were admitted to hospital for a median (interquartile range) length of stay of 12 (5-34) days. All-cause case-fatality rates in hospital by day 30 and by day 90 were 30 (14%), 28 (13%), and 42 (20%), respectively. The 90-day case-fatality rate increased with increasing comorbidity and was 3% (1/37), 11% (3/27), 25% (10/40), and 27% (28/105) among those with Charlson Comorbidity Indices of 0, 1, 2, and 3+, respectively ( = 0.004).
Although comorbidity is an important determinant of risk, most sp. BSI are of community-onset and one-fifth of cases occur in patients without significant underlying chronic co-morbidities. This study highlights the value of population-based methodologies to define the epidemiology of an infectious disease.
病例报告和小样本系列研究表明，某物种血流感染（BSI）最常见于慢性肺病患者住院期间的并发症。本研究的目的是确定澳大利亚人群中该物种BSI的发病率、危险因素和结局。
2000年至2019年期间，在澳大利亚昆士兰州（人口约500万）进行了基于实验室的回顾性监测。通过与州医院入院和人口动态统计数据库的关联获取临床和结局数据。在社区或住院的头两个日历日内诊断出的BSI被归类为社区发病。社区发病的BSIs分为社区相关和医疗保健相关。
在超过8600万人年的监测期间，195名个体发生了210起该物种BSI事件，总体年龄和性别标准化年发病率为每百万居民2.6例。老年人和男性风险最高（分别为每百万2.9例和2.0例，男性的发病率比值比为1.5；95%可信区间，1.1 - 1.9；P = 0.008）。大多数（153例；73%）病例为社区发病，其中100例（48%）和53例（25%）分别为医疗保健相关和社区相关。在二十年的监测期间，社区发病病例的比例呈上升趋势。基础疾病很常见，Charlson合并症指数（CCI）中位数（四分位间距）为3（1 - 5）。分别有37例（18%）、27例（13%）、40例（19%）和105例（50%）病例的CCI评分为0、1、2和3分及以上。除1例病例外，所有病例均住院，住院时间中位数（四分位间距）为12天（5 - 34天）。第30天和第90天的全因住院病死率分别为30例（14%）、28例（13%）和42例（20%）。90天病死率随合并症增加而升高，Charlson合并症指数为0、1、2和3分及以上的患者中，90天病死率分别为3%（1/37）、11%（3/27）、25%（10/40）和27%（28/105）（P = 0.004）。
虽然合并症是风险的重要决定因素，但大多数该物种BSI为社区发病，五分之一的病例发生在无明显基础慢性合并症的患者中。本研究强调了基于人群的方法在确定传染病流行病学方面的价值。
