Chandroulis Ioannis, Schinas Georgios, de Lastic Anne-Lise, Polyzou Eleni, Tsoupra Stamatia, Davoulos Christos, Kolosaka Martha, Niarou Vasiliki, Theodoraki Spyridoula, Ziazias Dimitrios, Kosmopoulou Foteini, Koutsouri Christina-Panagiota, Gogos Charalambos, Akinosoglou Karolina
School of Social Sciences, Hellenic Open University, 263 35 Patras, Greece.
School of Medicine, University of Patras, 265 04 Rio, Greece.
Pathogens. 2024 Aug 9;13(8):677. doi: 10.3390/pathogens13080677.
Bloodstream infections (BSIs) can be primary or secondary, with significant associated morbidity and mortality. Primary bloodstream infections (BSIs) are defined as infections where no clear infection source is identified, while secondary BSIs originate from a localized infection site. This study aims to compare patterns, outcomes, and medical costs between primary and secondary BSIs and identify associated factors. Conducted at the University Hospital of Patras, Greece, from May 2016 to May 2018, this single-center retrospective cohort study included 201 patients with confirmed BSIs based on positive blood cultures. Data on patient characteristics, clinical outcomes, hospitalization costs, and laboratory parameters were analyzed using appropriate statistical methods. Primary BSIs occurred in 22.89% (46 patients), while secondary BSIs occurred in 77.11% (155 patients). Primary BSI patients were younger and predominantly nosocomial, whereas secondary BSI was mostly community-acquired. Clinical severity scores (SOFA, APACHE II, SAPS, and qPitt) were significantly higher in primary compared to secondary BSI. The median hospital stay was longer for primary BSI (21 vs. 12 days, < 0.001). Although not statistically significant, mortality rates were higher in primary BSI (43.24% vs. 26.09%). Total care costs were significantly higher for primary BSI (EUR 4388.3 vs. EUR 2530.25, = 0.016), driven by longer hospital stays and increased antibiotic costs. This study underscores the distinct clinical and economic challenges of primary versus secondary BSI and emphasizes the need for prompt diagnosis and tailored antimicrobial therapy. Further research should focus on developing specific management guidelines for primary BSI and exploring interventions to reduce BSI burden across healthcare settings.
血流感染（BSIs）可分为原发性或继发性，伴有显著的相关发病率和死亡率。原发性血流感染（BSIs）被定义为未发现明确感染源的感染，而继发性BSIs则起源于局部感染部位。本研究旨在比较原发性和继发性BSIs的模式、结局和医疗成本，并确定相关因素。该单中心回顾性队列研究于2016年5月至2018年5月在希腊帕特雷大学医院进行，纳入了201例血培养阳性确诊为BSIs的患者。使用适当的统计方法分析了患者特征、临床结局、住院费用和实验室参数的数据。原发性BSIs发生在22.89%（46例患者），而继发性BSIs发生在77.11%（155例患者）。原发性BSI患者更年轻，主要为医院获得性感染，而继发性BSI大多为社区获得性感染。与继发性BSI相比，原发性BSI的临床严重程度评分（SOFA、APACHE II、SAPS和qPitt）显著更高。原发性BSI的中位住院时间更长（21天对12天，<0.001）。尽管无统计学意义，但原发性BSI的死亡率更高（43.24%对26.09%）。由于住院时间延长和抗生素费用增加，原发性BSI的总护理费用显著更高（4388.3欧元对2530.25欧元，=0.016）。本研究强调了原发性与继发性BSI在临床和经济方面的不同挑战，并强调了及时诊断和针对性抗菌治疗的必要性。进一步的研究应侧重于制定原发性BSI的具体管理指南，并探索在整个医疗环境中减轻BSI负担的干预措施。
