Division of Infectious Diseases, Seoul Medical Center, Seoul, South Korea.
Center for Antimicrobial Resistance and Microbial Genetics, University of Ulsan College of Medicine, Seoul, South Korea.
Sci Rep. 2024 Jul 5;14(1):15472. doi: 10.1038/s41598-024-66520-0.
This study evaluated the determinants of mortality and the T cell immune response in patients with persistent Staphylococcus aureus bacteremia (SAB). This was a prospective cohort study and patients with confirmed SAB were enrolled from 2008 to 2020. We compared clinical, microbiological, and genotypic features between surviving and deceased patients with persistent SAB. The concentrations of cytokines and the proportions of IFN-γ secreting CD4 T cells were measured serially during the bacteremia period. Of the 1760 patients, 242 had persistent bacteremia (PB), and 49 PB patients died within 30 days. In the multivariate analysis, the APACHE II score and female sex were independently associated with 30 days mortality. The level of IL-10 was significantly increased in the plasma of patients with a high Pitt bacteremia score and those who died within 12 weeks from the index day. The proportion of IFN-γ-secreting CD4 T cells were the highest just before the positive-to-negative conversion of blood cultures in patients with a low Pitt bacteremia score and those who survived for 12 weeks. The level of IL-10 is correlated with clinical outcomes in PB patients. IFN-γ secreting CD4 T cells might play a pivotal role in SAB PB.
本研究评估了持续性金黄色葡萄球菌菌血症（SAB）患者的死亡率和 T 细胞免疫应答的决定因素。这是一项前瞻性队列研究，纳入了 2008 年至 2020 年间确诊为 SAB 的患者。我们比较了存活和死亡的持续性 SAB 患者的临床、微生物学和基因型特征。在菌血症期间连续测量细胞因子浓度和 IFN-γ 分泌的 CD4 T 细胞比例。在 1760 名患者中，有 242 名患有持续性菌血症（PB），49 名 PB 患者在 30 天内死亡。多变量分析显示，APACHE II 评分和女性与 30 天死亡率独立相关。高 Pitt 菌血症评分和从指数日起 12 周内死亡的患者血浆中 IL-10 水平显著升高。在 Pitt 菌血症评分低的患者和存活 12 周的患者中，血培养由阳性转为阴性之前，IFN-γ 分泌的 CD4 T 细胞比例最高。IL-10 水平与 PB 患者的临床结局相关。IFN-γ 分泌的 CD4 T 细胞可能在 SAB PB 中起关键作用。
