Kovács Krisztina, Nyul Adrienn, Lutz Zsolt, Mestyán Gyula, Gajdács Márió, Urbán Edit, Sonnevend Ágnes
Department of Medical Microbiology and Immunology, Clinical Centre, Medical School, University of Pécs, Szigeti út 12, 7624 Pécs, Hungary.
Department of Oral Biology and Experimental Dental Research, Faculty of Dentistry, University of Szeged, 6720 Szeged, Hungary.
Antibiotics (Basel). 2022 Sep 28;11(10):1326. doi: 10.3390/antibiotics11101326.
Strict anaerobes have been reported to account for 0.5-13% of episodes of bacteremia in the adult population, with a growing awareness among clinicians regarding anaerobic bacteremia, especially in patients with specific predisposing factors. The aim of our present study was to assess the incidence and clinical characteristics of anaerobic bacteremia during a 5-year period (2016-2020) at a tertiary care teaching hospital, and to compare our findings with other studies in Hungary. Overall, = 160 strict anaerobes were detected, out of which, 44.4% ( = 71; 0.1% of positive blood cultures, 0.1/1000 hospitalizations, 3.3/100,000 patient days) were clinically significant, while spp. accounted for 55.6% ( = 89) of isolates. Among relevant pathogens, the spp. group (32.4%; = 23), spp. (22.5%; = 16) and Gram-positive anaerobic cocci (15.5%; = 11) were the most common. The mean age of patients was 67.1 ± 14.1 years, with a male majority (59.2%; = 42). A total of 38.0% of patients were affected by a malignancy or immunosuppression, while an abscess was identified in 15.5% of cases. A total of 74.7% ( = 53) of patients received antibiotics prior to blood culture sampling; in instances where antimicrobials were reported, anaerobic coverage of the drugs was appropriate in 52.1% ( = 37) of cases. The 30-day crude mortality rate was 39.4% ( = 28); age ≥ 75 years was a significant predictor of 30-day mortality (OR: 5.0; CI: 1.8-14.4; = 0.003), while malignancy and immunosuppression, lack of anti-anaerobic coverage or female sex did not show a significant relationship with the mortality of these patients. Early recognition of the role played by anaerobes in sepsis and timely initiation of adequate, effective antimicrobial treatment have proven efficient in reducing the mortality of patients affected by anaerobic bacteremia.
据报道,严格厌氧菌在成年人群菌血症发作病例中占0.5%-13%,临床医生对厌氧性菌血症的认识不断提高,尤其是在有特定易感因素的患者中。我们当前研究的目的是评估一家三级护理教学医院在5年期间(2016 - 2020年)厌氧性菌血症的发病率和临床特征,并将我们的研究结果与匈牙利的其他研究进行比较。总体而言,共检测到160株严格厌氧菌,其中44.4%(n = 71;占血培养阳性结果的0.1%,每1000次住院中的0.1%,每100,000患者日中的3.3%)具有临床意义,而拟杆菌属占分离株的55.6%(n = 89)。在相关病原体中,拟杆菌属组(32.4%;n = 23)、普雷沃菌属(22.5%;n = 16)和革兰氏阳性厌氧球菌(15.5%;n = 11)最为常见。患者的平均年龄为67.1±14.1岁,男性居多(59.2%;n = 42)。共有38.0%的患者患有恶性肿瘤或免疫抑制,而15.5%的病例发现有脓肿。共有74.7%(n = 53)的患者在进行血培养采样前接受了抗生素治疗;在报告使用抗菌药物的情况下,52.1%(n = 37)的病例中药物对厌氧菌的覆盖是合适的。30天的粗死亡率为39.4%(n = 28);年龄≥75岁是30天死亡率的显著预测因素(OR:5.0;CI:1.8 - 14.4;P = 0.003),而恶性肿瘤和免疫抑制、缺乏抗厌氧菌覆盖或女性性别与这些患者的死亡率没有显著关系。早期认识到厌氧菌在脓毒症中的作用并及时开始充分、有效的抗菌治疗已被证明可有效降低厌氧性菌血症患者的死亡率。