传染病会诊在长期护理机构发热患者管理中的作用。
The role of infectious disease consultations in the management of patients with fever in a long-term care facility.
机构信息
Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
出版信息
PLoS One. 2023 Sep 8;18(9):e0291421. doi: 10.1371/journal.pone.0291421. eCollection 2023.
BACKGROUND
Infectious disease (ID) clinicians can provide essential services for febrile patients in tertiary hospitals. The aim of this study was to evaluate the role of ID consultations (IDC) in managing hospitalized patients with infections in an oriental medical hospital (OMH), which serves as a long-term care facility. To our knowledge, this is the first study on the role of IDCs in managing patients in an OMH.
METHODS
This retrospective study was conducted in an OMH in Seoul, Korea, from June 2006 to June 2013.
RESULTS
Among the 465 cases of hospital-acquired fever, 141 (30.3%) were referred for ID. The most common cause of fever was infection in both groups. The peak body temperature of the patient was higher in IDC group (38.8±0.6°C vs. 38.6±0.5°C, p<0.001). Crude mortality at 30 days (14.6% vs. 7.8%, p = 0.043) and infection-attributable mortality (15.3% vs. 6.7%, p = 0.039) were higher in the No-IDC group. Multivariable analysis showed that infection as the focus of fever (adjusted Odd ratio [aOR] 3.49, 95% confidence interval (CI) 1.64-7.44), underlying cancer (aOR 10.32, 95% CI 4.34-24.51,), and multiorgan dysfunction syndrome (aOR 15.68, 95% CI 2.06-119.08) were associated with increased 30-day mortality. Multivariate analysis showed that in patients with infectious fever, appropriate antibiotic therapy (aOR 0.19, 95% CI 0.05-0.76) was the only factor associated with decreased infection-attributable mortality while underlying cancer (aOR 7.80, 95% CI 2.555-23.807) and severe sepsis or septic shock at the onset of fever (aOR 10.15, 95% CI 1.00-102.85) were associated with increased infection-attributable mortality.
CONCLUSION
Infection was the most common cause of fever in patients hospitalized for OMH. Infection as the focus of fever, underlying cancer, and MODS was associated with increased 30-day mortality in patients with nosocomial fever. Appropriate antibiotic therapy was associated with decreased infection-attributable mortality in patients with infectious fever.
背景
传染病（ID）临床医生可以为三级医院的发热患者提供重要服务。本研究的目的是评估 ID 咨询（IDC）在管理东方医院（OMH）感染住院患者中的作用，该医院是一家长期护理机构。据我们所知，这是第一项关于 IDC 在管理 OMH 患者方面作用的研究。
方法
这项回顾性研究在韩国首尔的一家 OMH 进行，时间为 2006 年 6 月至 2013 年 6 月。
结果
在 465 例医院获得性发热中，有 141 例（30.3%）因 ID 而转介。两组发热的最常见原因均为感染。IDC 组患者的最高体温更高（38.8±0.6°C 比 38.6±0.5°C，p<0.001）。30 天粗死亡率（14.6%比 7.8%，p=0.043）和感染相关死亡率（15.3%比 6.7%，p=0.039）在无 IDC 组更高。多变量分析显示，发热的感染焦点（调整后的优势比[aOR]3.49，95%置信区间[CI]1.64-7.44）、基础癌症（aOR 10.32，95%CI 4.34-24.51，）和多器官功能障碍综合征（aOR 15.68，95%CI 2.06-119.08）与 30 天死亡率增加相关。多变量分析显示，在感染性发热患者中，适当的抗生素治疗（aOR 0.19，95%CI 0.05-0.76）是与感染相关死亡率降低相关的唯一因素，而基础癌症（aOR 7.80，95%CI 2.555-23.807）和发热时严重败血症或感染性休克（aOR 10.15，95%CI 1.00-102.85）与感染相关死亡率增加相关。
结论
感染是 OMH 住院患者发热的最常见原因。发热的感染焦点、基础癌症和 MODS 与医院获得性发热患者的 30 天死亡率增加相关。适当的抗生素治疗与感染性发热患者的感染相关死亡率降低相关。
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