Aysert-Yıldız Pınar, Yıldız Yeşim, Habibi Hamid, Eser Sedanur, Özgen-Top Özge, Özger Hasan Selçuk, Dizbay Murat
Department of Infectious Diseases and Clinical Microbiology, Gazi University School of Medicine, Ankara, Turkey.
Infect Dis Clin Microbiol. 2022 Dec 21;4(4):258-267. doi: 10.36519/idcm.2022.187. eCollection 2022 Dec.
There are many difficulties in diagnosing and treating bacteremia. In this study, we aimed to evaluate "true" and "false-positive bacteremia" and assess mortality risk factors and the impact of different treatment regimens.
Hospitalized adult patients with -positive blood cultures were assessed by a two-stage analysis. First, the clinical significance of blood cultures was assessed, and patients were divided into "true" and "false-positive bacteremia" groups. Then, excluding false positives, we analyzed the antimicrobial regimens and the factors associated with 28-day mortality in true bacteremia cases performing univariate and multivariate analyses.
The study included 127 out of 138 patients with bacteremia. True bacteremia was identified in 51.2% and false-positive bacteremia in 48.8% of patients. In the true bacteremia group, hypotension, nosocomial bacteremia, concomitant infections, a source of bacteremia, two positive blood culture sets, and 28-day mortality were more common. The 28-day mortality was 50.7% among true bacteremia cases. In multivariate analysis, age and solid tumor were the independent predictors of 28-day mortality. Early effective antimicrobial therapy and different antimicrobial regimens, including trimethoprim-sulfamethoxazole (SXT), fluoroquinolones (FQs), and tigecycline (TGC), did not have any significant impact on survival.
Patients with bacteremia should first be assessed regarding clinical significance. Clinical findings, the presence of multiple positive blood culture sets and the primary sources of bacteremia are useful parameters while discriminating true from false-positive bacteremia. Patients with advanced age and solid tumors should be followed carefully in terms of mortality. Antimicrobial regimens, including SXT, FQs, or TGC, can be preferred in patients with bacteremia considering antimicrobial resistance and adverse effects or toxicity.
菌血症的诊断和治疗存在诸多困难。在本研究中，我们旨在评估“真性”和“假阳性菌血症”，并评估死亡风险因素以及不同治疗方案的影响。
对住院的血培养阳性成年患者进行两阶段分析。首先，评估血培养的临床意义，将患者分为“真性”和“假阳性菌血症”组。然后，排除假阳性病例，我们对真性菌血症病例的抗菌治疗方案以及与28天死亡率相关的因素进行单因素和多因素分析。
该研究纳入了138例菌血症患者中的127例。51.2%的患者被诊断为真性菌血症，48.8%的患者为假阳性菌血症。在真性菌血症组中，低血压、医院获得性菌血症、合并感染、菌血症来源、两份血培养阳性以及28天死亡率更为常见。真性菌血症病例的28天死亡率为50.7%。多因素分析中，年龄和实体瘤是28天死亡率的独立预测因素。早期有效的抗菌治疗以及不同的抗菌方案，包括复方新诺明（SXT）、氟喹诺酮类（FQs）和替加环素（TGC），对生存率没有显著影响。
对于菌血症患者，应首先评估其临床意义。临床发现、多份血培养阳性以及菌血症的主要来源是区分真性与假阳性菌血症的有用参数。对于高龄和患有实体瘤的患者，应密切关注其死亡率。考虑到抗菌药物耐药性以及不良反应或毒性，菌血症患者可优先选用包括SXT、FQs或TGC在内的抗菌方案。
