Fourre Nicolas, Zimmermann Virgile, Senn Laurence, Aruanno Marion, Guery Benoit, Papadimitriou-Olivgeris Matthaios
Infectious Diseases Service, Lausanne University Hospital, Lausanne, Switzerland.
Infection Prevention and Control Unit, Lausanne University Hospital, Lausanne, Switzerland.
Clin Infect Dis. 2024 Jun 14;78(6):1544-1550. doi: 10.1093/cid/ciae168.
Streptococcal bacteremia is associated with high mortality. Thia study aims to identify predictors of mortality among patients with streptococcal bacteremia.
This retrospective study was conducted at the Lausanne University Hospital, Switzerland, and included episodes of streptococcal bacteremia among adult patients from 2015 to 2023.
During the study period, 861 episodes of streptococcal bacteremia were included. The majority of episodes were categorized in the Mitis group (348 episodes; 40%), followed by the Pyogenic group (215; 25%). Endocarditis was the most common source of bacteremia (164; 19%). The overall 14-day mortality rate was 8% (65 episodes). The results from the Cox multivariable regression model showed that a Charlson comorbidity index >4 (P .001; hazard ratio [HR], 2.87; confidence interval [CI]: 1.58-5.22), Streptococcus pyogenes (P = .011; HR, 2.54;CI: 1.24-5.21), sepsis (P < .001; HR, 7.48; CI: 3.86-14.47), lower respiratory tract infection (P = .002; HR, 2.62; CI: 1.42-4.81), and absence of source control interventions within 48 hours despite being warranted (P = .002; HR, 2.62; CI: 1.43-4.80) were associated with 14-day mortality. Conversely, interventions performed within 48 hours of bacteremia onset, such as infectious diseases consultation (P < .001; HR, 0.29; CI: .17-.48) and appropriate antimicrobial treatment (P < .001; HR, .28; CI: .14-.57), were associated with improved outcome.
Our findings underscore the pivotal role of infectious diseases consultation in guiding antimicrobial treatment and recommending source control interventions for patients with streptococcal bacteremia.
链球菌菌血症与高死亡率相关。本研究旨在确定链球菌菌血症患者的死亡预测因素。
这项回顾性研究在瑞士洛桑大学医院进行，纳入了2015年至2023年成年患者的链球菌菌血症发作病例。
在研究期间，共纳入861例链球菌菌血症发作病例。大多数发作病例归类于轻链球菌组（348例；40%），其次是化脓性链球菌组（215例；25%）。心内膜炎是最常见的菌血症来源（164例；19%）。总体14天死亡率为8%（65例）。Cox多变量回归模型结果显示，Charlson合并症指数>4（P = 0.001；风险比[HR]，2.87；置信区间[CI]：1.58 - 5.22）、化脓性链球菌（P = 0.011；HR，2.54；CI：1.24 - 5.21）、脓毒症（P < 0.001；HR，7.48；CI：3.86 - 14.47）、下呼吸道感染（P = 0.002；HR，2.62；CI：1.42 - 4.81）以及尽管有必要但在48小时内未进行源头控制干预（P = 0.002；HR，2.62；CI：1.43 - 4.80）与14天死亡率相关。相反，在菌血症发作后48小时内进行的干预，如感染病会诊（P < 0.001；HR，0.29；CI：0.17 - 0.48）和适当的抗菌治疗（P < 0.001；HR，0.28；CI：0.14 - 0.57）与改善的预后相关。
我们的研究结果强调了感染病会诊在指导抗菌治疗以及为链球菌菌血症患者推荐源头控制干预方面的关键作用。
