Macfarlane D E, Narla V R
J Infect. 1985 Mar;10(2):126-42. doi: 10.1016/s0163-4453(85)91564-6.
A total of 222 cases of septicaemia was recorded at the University Hospital of the West Indies between June 1982 and June 1983. This gave an overall incidence of 16.1 per 1000 admissions. The 233 bacterial strains isolated comprised 100 Gram-positive and 133 Gram-negative organisms with Klebsiella pneumoniae, Streptococcus pneumoniae and Staphylococcus aureus being the most frequent. Highest rates of septicaemia were recorded in patients less than 1 year and over 50 years of age. Septicaemia caused by Gram-positive organisms was predominantly a disease of children whereas that caused by Gram-negative organisms arose more often in neonates and in patients over 50 years of age. A predisposing factor was noted in 104 patients of whom 42 had neoplastic disease. The most frequently identified initial sites of infection were the respiratory tract, the gastro-intestinal tract and the meninges. Most blood stream infections were community-acquired, three quarters of all septicaemic patients being admitted to the departments of medicine or paediatrics. There were 11 cases of polymicrobial septicaemia caused predominantly by Gram-negative organisms in patients with underlying disease. Appropriate antimicrobial drugs were administered to 57% of septicaemic patients whereas 17% received superfluous antimicrobial therapy. In those patients who received inappropriate antimicrobial therapy there was a marked increase in mortality. Forty of 61 deaths were attributed to septicaemia. Mortality from septicaemia caused by Gram-negative organisms was 21% compared with 13% for that caused by Gram-positive organisms. The organisms associated with the highest case fatality rates were Escherichia coli, 53%; Enterobacter sp., 27%; and beta-haemolytic streptococci 24%. There were no deaths from septicaemia caused by Haemophilus influenzae, Salmonella sp. or Serratia sp. The highest mortality rates were associated with neoplastic disease, diabetes, polymicrobial septicaemia, urinary tract infections and old age.
1982年6月至1983年6月期间，西印度群岛大学医院共记录了222例败血症病例。总体发病率为每1000例入院患者中有16.1例。分离出的233株细菌包括100株革兰氏阳性菌和133株革兰氏阴性菌，其中肺炎克雷伯菌、肺炎链球菌和金黄色葡萄球菌最为常见。败血症发病率最高的是年龄小于1岁和大于50岁的患者。革兰氏阳性菌引起的败血症主要是儿童疾病，而革兰氏阴性菌引起的败血症在新生儿和50岁以上患者中更为常见。104例患者存在易感因素，其中42例患有肿瘤疾病。最常确定的初始感染部位是呼吸道、胃肠道和脑膜。大多数血流感染是社区获得性的，所有败血症患者中有四分之三被收治到内科或儿科。有11例多微生物败血症主要由患有基础疾病患者的革兰氏阴性菌引起。57%的败血症患者接受了适当的抗菌药物治疗，而17%的患者接受了多余的抗菌治疗。在接受不适当抗菌治疗的患者中，死亡率显著增加。61例死亡中有40例归因于败血症。革兰氏阴性菌引起的败血症死亡率为21%，而革兰氏阳性菌引起的败血症死亡率为13%。病死率最高的相关细菌是大肠杆菌，为53%；肠杆菌属，为27%；以及β溶血性链球菌，为24%。由流感嗜血杆菌、沙门氏菌属或沙雷氏菌属引起的败血症无死亡病例。最高死亡率与肿瘤疾病、糖尿病、多微生物败血症、尿路感染和老年有关。
