Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Online Research Club.
Hosp Pract (1995). 2022 Dec;50(5):407-415. doi: 10.1080/21548331.2022.2133414. Epub 2022 Nov 7.
Sepsis and septic shock have high mortality rates and often require a prolonged hospital stay. Patient outcomes may vary according to multiple factors. We aim to determine the prevalence of antimicrobial resistance and factors associated with mortality and hospital stay.
Clinical and microbiological data of patients with sepsis or septic shock were retrospectively collected for 15 months. Patients with negative blood cultures and patients that did not meet the SEPSIS 3 criteria were excluded.
We included 48 septic shock and 28 septic patients (mean APACHE II 20.32 ± 5.61 and mean SOFA 9.41 ± 3.17), with a mean age of 60.5 ± 16.8 years and 56.6% males. WBCs, neutrophils, INR, and fibrinogen levels were significantly associated with mortality. 59.5% of the cultured bacteria were gram-negative (most common E. coli) and 27.8% were gram-positive (most common ), while 7.6% were other types of bacteria and 5.1% were fungi. Resistance patterns to gram-negative were varying, and resistance to piperacillin/tazobactam, carbapenems, and aminoglycosides were from 60% to 100% (), while they were highly sensitive to Colistin. was also resistant to ceftriaxone (77.8%) and sulbactam/cefoperazone (44.4%). Resistance rates for Gram-positives were high, from 86% to 100% for oxacillin, while for vancomycin, teicoplanin, and linezolid, they were often low but arrived up to 42.8%. According to our logistic regression analysis, patients over 65 year-old and those who received corticosteroids had a significantly increased risk of in-hospital mortality (OR: 4.0; OR: 4.8).
Sepsis still poses a significant threat to patients' health, even when positive blood culture results allow the administration of specific antibiotic treatment.
脓毒症和感染性休克的死亡率很高，通常需要长时间住院治疗。患者的预后可能因多种因素而异。我们旨在确定抗生素耐药性的流行情况以及与死亡率和住院时间相关的因素。
回顾性收集了 15 个月内脓毒症或感染性休克患者的临床和微生物学数据。排除了血培养阴性和不符合 SEPSIS 3 标准的患者。
我们纳入了 48 例感染性休克和 28 例感染性休克患者（平均 APACHE II 20.32 ± 5.61，SOFA 平均 9.41 ± 3.17），平均年龄 60.5 ± 16.8 岁，男性占 56.6%。白细胞计数、中性粒细胞计数、INR 和纤维蛋白原水平与死亡率显著相关。培养的细菌中 59.5%为革兰阴性菌（最常见的是大肠杆菌），27.8%为革兰阳性菌（最常见的是 ），7.6%为其他类型的细菌，5.1%为真菌。革兰阴性菌的耐药模式各不相同，对哌拉西林/他唑巴坦、碳青霉烯类和氨基糖苷类的耐药率为 60%至 100%（），而对黏菌素高度敏感。也对头孢曲松（77.8%）和头孢噻肟/舒巴坦（44.4%）耐药。革兰阳性菌的耐药率也很高，对苯唑西林的耐药率为 86%至 100%，而对万古霉素、替考拉宁和利奈唑胺的耐药率通常较低，但也高达 42.8%。根据我们的逻辑回归分析，65 岁以上的患者和接受皮质类固醇治疗的患者住院死亡率显著增加（OR：4.0；OR：4.8）。
即使阳性血培养结果允许使用特定的抗生素治疗，脓毒症仍然对患者的健康构成重大威胁。
