Underwood Jonathan, Griffiths Rowena, Gillespie David, Akbari Ashley, Ahmed Haroon
Division of Infection and Immunity, Cardiff University, Cardiff, UK.
Department of Infectious Diseases, Cardiff and Vale University Health Board, Cardiff, UK.
Open Forum Infect Dis. 2024 Mar 6;11(5):ofae126. doi: 10.1093/ofid/ofae126. eCollection 2024 May.
Bloodstream infections (BSIs) are common, life-threatening infections. However, it remains unclear whether deaths following BSIs are primarily from uncontrolled infection or underlying comorbidities. We aimed to determine the overall mortality, infection-attributable mortality, and causes of death for four leading BSI pathogens.
This retrospective cohort study was conducted within the Secure Anonymized Information Linkage Databank, containing anonymized population-scale electronic health record data for Wales, UK. We included adults with , spp, , and BSI between 2010 and 2022 using linked data from Public Health Wales and the Office for National Statistics. Thirty-day all-cause and sepsis-specific mortality, as a proxy for infection-attributable mortality, were compared using Cox proportional hazards and competing risk regression, respectively.
We identified 35 691 adults with BSI (59.6% ). Adjusted analyses revealed that all organisms had a higher 30-day mortality versus with the highest (hazard ratio, 1.96 [1.76-2.17], < .001). Cancer was the leading cause of death following BSIs for all organisms, particularly deaths occurring between 30 and 90 days (35.9%). A total of 25.5% of deaths within 30 days involved sepsis. Methicillin-resistant was associated with the highest sepsis mortality versus (hazard ratio, 2.56 [2.10-3.12], < .001). Peak C-reactive protein was positively associated with increased sepsis mortality ( < .001).
This population-level study challenges the assumption that most deaths following BSIs are directly attributable to uncontrolled infection, particularly subacutely more than 30 days from BSI. Our findings underscore the need for reevaluating clinical trial design and developing better preventive strategies for BSIs.
血流感染（BSIs）是常见的、危及生命的感染。然而，BSIs后的死亡主要是由于感染控制不佳还是潜在的合并症尚不清楚。我们旨在确定四种主要BSI病原体的总体死亡率、感染归因死亡率和死亡原因。
这项回顾性队列研究在安全匿名信息链接数据库中进行，该数据库包含英国威尔士的匿名人口规模电子健康记录数据。我们使用威尔士公共卫生部门和国家统计局的关联数据，纳入了2010年至2022年间患有金黄色葡萄球菌、大肠埃希菌、肺炎克雷伯菌和鲍曼不动杆菌BSI的成年人。分别使用Cox比例风险模型和竞争风险回归比较30天全因死亡率和脓毒症特异性死亡率，作为感染归因死亡率的替代指标。
我们确定了35691例患有BSI的成年人（59.6%为男性）。调整分析显示，所有病原体的30天死亡率均高于甲氧西林敏感金黄色葡萄球菌，其中金黄色葡萄球菌最高（风险比，1.96[1.76 - 2.17]，P <.001）。癌症是所有病原体BSIs后死亡的主要原因，特别是在30至90天之间发生的死亡（35.9%）。30天内共有25.5%的死亡与脓毒症有关。耐甲氧西林金黄色葡萄球菌的脓毒症死亡率高于甲氧西林敏感金黄色葡萄球菌（风险比，2.56[2.10 - 3.12]，P <.001）。C反应蛋白峰值与脓毒症死亡率增加呈正相关（P <.001）。
这项人群水平的研究挑战了BSIs后大多数死亡直接归因于感染控制不佳的假设，特别是在BSI发生30天以上的亚急性阶段。我们的研究结果强调了重新评估临床试验设计和制定更好的BSIs预防策略的必要性。
