Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamentos de Medicina y Microbiología, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain.
Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamentos de Medicina y Microbiología, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Sevilla, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
Clin Microbiol Infect. 2024 Aug;30(8):1035-1041. doi: 10.1016/j.cmi.2024.04.001. Epub 2024 Apr 8.
This study aimed to determine the association of Escherichia coli microbiological factors with 30-day mortality in patients with bloodstream infection (BSI) presenting with a dysregulated response to infection (i.e. sepsis or septic shock).
Whole-genome sequencing was performed on 224 E coli isolates of patients with sepsis/septic shock, from 22 Spanish hospitals. Phylogroup, sequence type, virulence, antibiotic resistance, and pathogenicity islands were assessed. A multivariable model for 30-day mortality including clinical and epidemiological variables was built, to which microbiological variables were hierarchically added. The predictive capacity of the models was estimated by the area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI).
Mortality at day 30 was 31% (69 patients). The clinical model for mortality included (adjusted OR; 95% CI) age (1.04; 1.02-1.07), Charlson index ≥3 (1.78; 0.95-3.32), urinary BSI source (0.30; 0.16-0.57), and active empirical treatment (0.36; 0.11-1.14) with an AUROC of 0.73 (95% CI, 0.67-0.80). Addition of microbiological factors selected clone ST95 (3.64; 0.94-14.04), eilA gene (2.62; 1.14-6.02), and astA gene (2.39; 0.87-6.59) as associated with mortality, with an AUROC of 0.76 (0.69-0.82).
Despite having a modest overall contribution, some microbiological factors were associated with increased odds of death and deserve to be studied as potential therapeutic or preventive targets.
本研究旨在确定大肠埃希菌微生物因素与表现出感染失调反应（即败血症或感染性休克）的血流感染（BSI）患者 30 天死亡率之间的关联。
对来自 22 家西班牙医院的 224 例败血症/感染性休克患者的大肠埃希菌分离株进行全基因组测序。评估了菌系、序列类型、毒力、抗生素耐药性和致病性岛。建立了一个包括临床和流行病学变量的 30 天死亡率的多变量模型，然后按层次将微生物变量添加到模型中。使用 95%置信区间（CI）的接收者操作特征曲线（AUROC）估计模型的预测能力。
第 30 天死亡率为 31%（69 例）。死亡率的临床模型包括（调整后的 OR；95%CI）年龄（1.04；1.02-1.07）、Charlson 指数≥3（1.78；0.95-3.32）、尿源性 BSI 来源（0.30；0.16-0.57）和积极的经验性治疗（0.36；0.11-1.14），AUROC 为 0.73（95%CI，0.67-0.80）。选择微生物因素的克隆 ST95（3.64；0.94-14.04）、eilA 基因（2.62；1.14-6.02）和 astA 基因（2.39；0.87-6.59）与死亡率相关，AUROC 为 0.76（0.69-0.82）。
尽管整体贡献不大，但一些微生物因素与死亡风险增加有关，值得作为潜在的治疗或预防靶点进行研究。
