Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, ON, Canada.
Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Toronto, ON, Canada; ICES (formerly Institute for Clinical Evaluative Sciences), Toronto, ON, Canada; Public Health Ontario, Toronto, ON, Canada.
J Infect. 2024 Nov;89(5):106283. doi: 10.1016/j.jinf.2024.106283. Epub 2024 Sep 25.
For bloodstream infections (BSI), treatment and research have focused on short term mortality. The objective of this study was to describe the 1-year mortality and morbidity in survivors of bloodstream infection when compared to patients with negative blood cultures.
We conducted a population-based retrospective cohort study using Ontario administrative databases. Patients were included if they had a blood culture taken from January 1, 2014, to December 31, 2021, and survived past 30 days from blood culture collection. They were followed for the subsequent year. Outcomes were compared among patients with BSI and those without BSI, including all-cause mortality, stroke, myocardial infarction (MI), congestive heart failure (CHF) exacerbation, new start dialysis and admission to a long-term care (LTC) facility. Prognostic factors were balanced using overlap weighting of propensity scores, and a survival or competing risk model was used to describe time-to-event.
Of 981,341 patients undergoing blood culture testing, 99,080 (10.1%) patients had a BSI and 882,261 (89.9%) patients did not. Outcomes were all more common among those with BSI as compared to those without BSI, including all-cause mortality (16,764 [16.9%] vs. 84,480 [9.6%]), stroke (1016 [1.0%] vs. 4680 [0.5%]), MI (1043 [1.1%] vs. 4547 [0.5%]), CHF exacerbation (2643 [2.7%] vs. 13,200 [1.5%]), new start dialysis (1703 [1.7%] vs. 2749 [0.3%]), and LTC admission (4231 [4.3%] vs. 13,016 [1.5%]). BSI had an adjusted hazard ratio of 1.10 (95% CI 1.08-1.12, P < 0.0001) for mortality, subdistribution hazard ratio (sHR) of 1.27 (95% CI 1.19-1.37, P < 0.0001) for stroke, sHR of 1.18 (95% CI 1.10-1.26, P < 0.0001) for MI, sHR of 1.05 (95% CI 1.01-1.10, P = 0.0176) for CHF exacerbation, sHR of 3.42 (95% CI 3.21-3.64, P < 0.0001) for new start dialysis and sHR of 1.87 (95% CI 1.80-1.94, P < 0.0001) for LTC admission.
BSI survivors have substantial long-term mortality and morbidity including stroke, MI, new start dialysis and functional decline leading to LTC admission.
对于血流感染（BSI），治疗和研究主要集中在短期死亡率上。本研究的目的是描述血流感染幸存者在与阴性血培养患者相比时的 1 年死亡率和发病率。
我们使用安大略省行政数据库进行了一项基于人群的回顾性队列研究。如果患者在 2014 年 1 月 1 日至 2021 年 12 月 31 日期间进行了血培养，并在血培养采集后 30 天内存活，那么他们就符合入选条件。随后对他们进行了为期一年的随访。比较了 BSI 患者和无 BSI 患者的结局，包括全因死亡率、中风、心肌梗死（MI）、充血性心力衰竭（CHF）恶化、新开始透析和入住长期护理（LTC）设施。通过倾向评分重叠加权来平衡预后因素，并使用生存或竞争风险模型来描述时间事件。
在接受血培养检测的 981341 名患者中，有 99080 名（10.1%）患者患有 BSI，882261 名（89.9%）患者没有。与无 BSI 患者相比，BSI 患者的结局更为常见，包括全因死亡率（16764[16.9%] vs. 84480[9.6%]）、中风（1016[1.0%] vs. 4680[0.5%]）、MI（1043[1.1%] vs. 4547[0.5%]）、CHF 恶化（2643[2.7%] vs. 13200[1.5%]）、新开始透析（1703[1.7%] vs. 2749[0.3%]）和 LTC 入住（4231[4.3%] vs. 13016[1.5%]）。BSI 的调整后死亡率的危险比为 1.10（95%CI 1.08-1.12，P<0.0001），中风的亚分布危险比（sHR）为 1.27（95%CI 1.19-1.37，P<0.0001），MI 的 sHR 为 1.18（95%CI 1.10-1.26，P<0.0001），CHF 恶化的 sHR 为 1.05（95%CI 1.01-1.10，P=0.0176），新开始透析的 sHR 为 3.42（95%CI 3.21-3.64，P<0.0001），LTC 入住的 sHR 为 1.87（95%CI 1.80-1.94，P<0.0001）。
BSI 幸存者有较高的长期死亡率和发病率，包括中风、MI、新开始透析和功能下降导致入住 LTC。
