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危重症患者的抬高:一个新的敌人?

Upraising in Critically Ill Patients: A New Enemy?

作者信息

Dimopoulos George, Garnacho-Montero José, Paramythiotou Elisabeth, Gutierrez-Pizarraya Antonio, Gogos Charalambos, Adriansen-Pérez Maria, Diakaki Chrysa, Matthaiou Dimitrios K, Poulakou Garyphalia, Akinosoglou Karolina

机构信息

Department of Critical Care, Evgenidio Hospital, Medical School, National and Kapodistrian University of Athens, 157 72 Athens, Greece.

Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain.

出版信息

Diagnostics (Basel). 2023 Mar 15;13(6):1106. doi: 10.3390/diagnostics13061106.

Abstract

(), an important pathogen in immuno-compromised patients, has recently gained attention in patients admitted in intensive care units (ICU). We sought to investigate clinical features of infections caused by in ICU patients and identify risk factors for mortality. We conducted a retrospective study in two multivalent non-COVID-19 ICUs of tertiary-teaching hospitals in Greece and Spain, including patients with isolated from at least one clinical specimen along with clinical signs of infection. A total of 103 patients (66% male) were analyzed. Median age was 65.5 (54-73.3) years and mean APACHE II and SOFA scores upon ICU admission were 18.36 (±7.22) and 18.17 (±6.95), respectively. Pneumonia was the predominant clinical syndrome (72.8%), while 22% of cases were among hemato/oncology patients. Crude 28-day mortality rate was 54.8%, even though, 14-day clinical and microbiological response was 96%. Age, APACHE II on ICU admission, hemato-oncologic disease, and multi-organ failure were initially identified as potential predictors of mortality. In the multivariable analysis, only increasing age and hemato-oncologic disease were shown to be independent risk factors for 28-day mortality. High all-cause mortality was observed in critically ill patients with predominantly respiratory infections by , despite initial clinical and laboratory response after targeted treatment. The study elucidates a potentially worrisome emerging pathogen in the ICU.

摘要

()是免疫功能低下患者的一种重要病原体,最近在重症监护病房(ICU)收治的患者中受到关注。我们试图调查ICU患者中由()引起的感染的临床特征,并确定死亡风险因素。我们在希腊和西班牙的三级教学医院的两个多价非新冠ICU中进行了一项回顾性研究,纳入了从至少一份临床标本中分离出()并伴有感染临床症状的患者。共分析了103例患者(66%为男性)。中位年龄为65.5(54 - 73.3)岁,ICU入院时APACHE II和SOFA评分的平均值分别为18.36(±7.22)和18.17(±6.95)。肺炎是主要的临床综合征(72.8%),而22%的病例为血液/肿瘤患者。28天粗死亡率为54.8%,尽管14天的临床和微生物学反应率为96%。年龄、ICU入院时的APACHE II、血液肿瘤疾病和多器官功能衰竭最初被确定为死亡的潜在预测因素。在多变量分析中,仅年龄增长和血液肿瘤疾病被证明是28天死亡率的独立危险因素。尽管在针对性治疗后有初始临床和实验室反应,但在以()为主的呼吸道感染的重症患者中观察到高全因死亡率。该研究阐明了ICU中一种潜在令人担忧的新兴病原体。

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