Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Muhimbili National Hospital, Dar es Salaam, Tanzania.
PLoS One. 2024 Apr 16;19(4):e0302076. doi: 10.1371/journal.pone.0302076. eCollection 2024.
Polymicrobial bloodstream infections (BSI) are difficult to treat since empiric antibiotics treatment are frequently less effective against multiple pathogens. The study aimed to compare outcomes in patients with polymicrobial and monomicrobial BSIs.
The study was a retrospective case-control design conducted at Muhimbili National Hospital for data processed between July 2021 and June 2022. Cases were patients with polymicrobial BSI, and controls had monomicrobial BSI. Each case was matched to three controls by age, admitting ward, and duration of admission. Logistic regression was performed to determine independent risk factors for in-hospital and 30-day mortality.
Fifty patients with polymicrobial BSI and 150 with monomicrobial BSI were compared: the two arms had no significant differences in sex and comorbidities. The most frequent bacteria in polymicrobial BSI were Klebsiella pneumoniae 17% (17/100) and Enterobacter species 15% (15/100). In monomicrobial BSI, S. aureus 17.33% (26/150), Klebsiella pneumoniae 16.67% (25/150), and Acinetobacter species 15% (15/150) were more prevalent. Overall, isolates were frequently resistant to multiple antibiotics tested, and 52% (130/250) were multidrug resistance. The 30-day and in-hospital mortality were 33.5% (67/200) and 36% (72/200), respectively. On multivariable analysis, polymicrobial BSIs were independent risk factors for both in-hospital mortality (aOR 2.37, 95%CI 1.20-4.69, p = 0.01) and 30-day mortality (aOR 2.05, 95%CI 1.03-4.08), p = 0.04). In sub-analyses involving only neonates, polymicrobial BSI was an independent risk factor for both 30-day mortality (aOR 3.13, 95%CI 1.07-9.10, p = 0.04) and in-hospital mortality (aOR 5.08, 95%CI 1.60-16.14, p = 0.006). Overall, the median length of hospital stay post-BSIs was numerically longer in patients with polymicrobial BSIs.
Overall, polymicrobial BSI was a significant risk for mortality. Patients with polymicrobial BSI stay longer at the hospital than those with monomicrobial BSI. These findings call for clinicians to be more aggressive in managing polymicrobial BSI.
多微生物血流感染（BSI）很难治疗，因为经验性抗生素治疗对多种病原体通常效果不佳。本研究旨在比较多微生物和单微生物 BSI 患者的结局。
本研究为回顾性病例对照设计，在 2021 年 7 月至 2022 年 6 月期间在穆希比利国家医院进行数据处理。病例为多微生物 BSI 患者，对照组为单微生物 BSI 患者。每例病例按年龄、入院病房和入院时间与 3 例对照进行匹配。采用 logistic 回归确定院内和 30 天死亡率的独立危险因素。
比较了 50 例多微生物 BSI 患者和 150 例单微生物 BSI 患者：两组在性别和合并症方面无显著差异。多微生物 BSI 中最常见的细菌是肺炎克雷伯菌 17%（17/100）和肠杆菌科细菌 15%（15/100）。在单微生物 BSI 中，金黄色葡萄球菌 17.33%（26/150）、肺炎克雷伯菌 16.67%（25/150）和不动杆菌属细菌 15%（15/150）更为常见。总体而言，分离株对测试的多种抗生素经常耐药，52%（130/250）为多药耐药。30 天和院内死亡率分别为 33.5%（67/200）和 36%（72/200）。多变量分析显示，多微生物 BSI 是院内死亡率（aOR 2.37，95%CI 1.20-4.69，p=0.01）和 30 天死亡率（aOR 2.05，95%CI 1.03-4.08，p=0.04）的独立危险因素。在仅涉及新生儿的亚分析中，多微生物 BSI 是 30 天死亡率（aOR 3.13，95%CI 1.07-9.10，p=0.04）和院内死亡率（aOR 5.08，95%CI 1.60-16.14，p=0.006）的独立危险因素。总体而言，多微生物 BSI 患者的医院感染后住院时间中位数较长。
多微生物 BSI 总体上是死亡率的显著危险因素。多微生物 BSI 患者的住院时间比单微生物 BSI 患者长。这些发现呼吁临床医生更积极地治疗多微生物 BSI。
