Duke University School of Medicine, Durham, North Carolina, USA.
Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Houston, Texas, USA.
Clin Infect Dis. 2023 Feb 8;76(3):e1285-e1293. doi: 10.1093/cid/ciac638.
The causes and clinical characteristics of recurrent gram-negative bacterial bloodstream infections (GNB-BSI) are poorly understood.
We used a cohort of patients with GNB-BSI to identify clinical characteristics, microbiology, and risk factors associated with recurrent GNB-BSI. Bacterial genotyping (pulsed-field gel electrophoresis [PFGE] and whole-genome sequencing [WGS]) was used to determine whether episodes were due to relapse or reinfection. Multivariable logistic regression was used to identify risk factors for recurrence.
Of the 1423 patients with GNB-BSI in this study, 60 (4%) had recurrent GNB-BSI. Non-White race (odds ratio [OR], 2.35; 95% confidence interval [CI], 1.38-4.01; P = .002), admission to a surgical service (OR, 2.18; 95% CI, 1.26-3.75; P = .005), and indwelling cardiac device (OR, 2.73; 95% CI, 1.21-5.58; P = .009) were associated with increased risk for recurrent GNB-BSI. Among the 48 patients with recurrent GNB-BSI whose paired bloodstream isolates underwent genotyping, 63% were due to relapse (30 of 48) and 38% were due to reinfection (18 of 48) based on WGS. Compared with WGS, PFGE correctly differentiated relapse and reinfection in 98% (47 of 48) of cases. Median time to relapse and reinfection was similar (113 days; interquartile range [IQR], 35-222 vs 174 days; IQR, 69-599; P = .13). Presence of a cardiac device was associated with relapse (relapse: 7 of 27, 26%; nonrelapse: 65 of 988, 7%; P = .002).
In this study, recurrent GNB-BSI was most commonly due to relapse. PFGE accurately differentiated relapse from reinfection when compared with WGS. Cardiac device was a risk factor for relapse.
复发性革兰氏阴性菌血流感染（GNB-BSI）的病因和临床特征尚不清楚。
我们使用了一组 GNB-BSI 患者的队列，以确定与复发性 GNB-BSI 相关的临床特征、微生物学和危险因素。细菌基因分型（脉冲场凝胶电泳[PFGE]和全基因组测序[WGS]）用于确定发作是复发还是再感染。多变量逻辑回归用于确定复发的危险因素。
在本研究的 1423 例 GNB-BSI 患者中，有 60 例（4%）发生复发性 GNB-BSI。非白种人种族（比值比[OR]，2.35；95%置信区间[CI]，1.38-4.01；P=0.002）、入住外科服务（OR，2.18；95%CI，1.26-3.75；P=0.005）和留置心脏装置（OR，2.73；95%CI，1.21-5.58；P=0.009）与复发性 GNB-BSI 的风险增加相关。在 48 例复发性 GNB-BSI 患者中，其配对血培养分离株进行了基因分型，基于 WGS，63%（48 例中的 30 例）是复发，38%（48 例中的 18 例）是再感染。与 WGS 相比，PFGE 在 98%（48 例中的 47 例）的病例中正确区分了复发和再感染。复发和再感染的中位时间相似（113 天；四分位距[IQR]，35-222 与 174 天；IQR，69-599；P=0.13）。心脏装置的存在与复发相关（复发：27 例中的 7 例，26%；非复发：988 例中的 65 例，7%；P=0.002）。
在本研究中，复发性 GNB-BSI 最常见的原因是复发。与 WGS 相比，PFGE 能准确区分复发和再感染。心脏装置是复发的危险因素。
