Prinsloo Carmen, Smith Simon, Law Matthew, Hanson Josh
College of Medicine and Dentistry, James Cook University, Cairns Hospital, Cairns, QLD 4870, Australia.
Department of Medicine, Cairns Hospital, Cairns, QLD 4870, Australia.
Trop Med Infect Dis. 2023 Oct 24;8(11):481. doi: 10.3390/tropicalmed8110481.
Patients with melioidosis are commonly bacteraemic. However, the epidemiological characteristics, the microbiological findings, and the clinical associations of bacteraemia are incompletely defined. All cases of culture-confirmed melioidosis at Cairns Hospital in tropical Australia between January 1998 and June 2023 were reviewed. The presence of bacteraemia was determined and correlated with patient characteristics and outcomes; 332/477 (70%) individuals in the cohort were bacteraemic. In multivariable analysis, immunosuppression (odds ratio (OR) (95% confidence interval (CI)): (2.76 (1.21-6.27), = 0.02), a wet season presentation (2.27 (1.44-3.59), < 0.0001) and male sex (1.69 (1.08-2.63), = 0.02), increased the likelihood of bacteraemia. Patients with a skin or soft tissue infection (0.32 (0.19-0.57), < 0.0001) or without predisposing factors for melioidosis (0.53 (0.30-0.93), = 0.03) were less likely to be bacteraemic. Bacteraemia was associated with intensive care unit admission (OR (95%CI): 4.27 (2.35-7.76), < 0.0001), and death (2.12 (1.04-4.33), = 0.04). The median (interquartile range) time to blood culture positivity was 31 (26-39) hours. Patients with positive blood cultures within 24 h were more likely to die than patients whose blood culture flagged positive after this time (OR (95%CI): 11.05 (3.96-30.83), < 0.0001). Bacteraemia portends a worse outcome in patients with melioidosis. Its presence or absence might be used to help predict outcomes in cases of melioidosis and to inform optimal clinical management.
类鼻疽患者通常会出现菌血症。然而，菌血症的流行病学特征、微生物学发现及临床关联尚未完全明确。对1998年1月至2023年6月期间澳大利亚热带地区凯恩斯医院所有经培养确诊的类鼻疽病例进行了回顾性研究。确定菌血症的存在情况，并将其与患者特征及预后相关联；该队列中有332/477（70%）的个体出现菌血症。在多变量分析中，免疫抑制（比值比（OR）（95%置信区间（CI））：（2.76（1.21 - 6.27），P = 0.02）、雨季发病（2.27（1.44 - 3.59），P < 0.0001）和男性（1.69（1.08 - 2.63），P = 0.02）会增加菌血症的发生可能性。患有皮肤或软组织感染的患者（0.32（0.19 - 0.57），P < 0.0001）或无类鼻疽易感因素的患者（0.53（0.30 - 0.93），P = 0.03）发生菌血症的可能性较小。菌血症与入住重症监护病房相关（OR（95%CI）：4.27（2.35 - 7.76），P < 0.0001），且与死亡相关（2.12（1.04 - 4.33），P = 0.04）。血培养阳性的中位（四分位间距）时间为31（26 - 39）小时。血培养在24小时内呈阳性的患者比血培养在此时间之后呈阳性的患者死亡可能性更高（OR（95%CI）：11.05（3.96 - 30.83），P < 0.0001）。菌血症预示着类鼻疽患者的预后更差。其存在与否可用于帮助预测类鼻疽病例的预后，并为优化临床管理提供依据。
