Mohamed Shukri Nurul Rahatul Ilyani, Hassan Shamsul Kamalrujan, Md Noor Siti Suraiya, Ab Hamid Siti Azrin, Nik Mohamad Nik Abdullah, Wan Muhd Shukeri Wan Fadzlina, Mazlan Mohd Zulfakar
Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
Hospital Pakar Universiti Sains Malaysia, Kelantan, Malaysia.
Malays J Med Sci. 2024 Dec;31(6):160-177. doi: 10.21315/mjms2024.31.6.13. Epub 2024 Dec 31.
Hospital-acquired bloodstream infections (BSI) are associated with high morbidity and mortality rates. This study was conducted to describe the outcomes and the prognosis of hospital-acquired BSI in the Critical Care Unit, Hospital Pakar Universiti Sains Malaysia (HPUSM), as well as to identify associated factors of treatment failure and mortality at 28 days.
This prospective cohort study was conducted in the Critical Care Unit of HPUSM from September 2019 to March 2021. Eligible participants included patients with a positive blood culture recorded after 48 hours of admission to hospital.
There was a total of 250 patients, whose positive blood cultures were isolated. The main isolated organisms were (23.6%), spp. (19.2%), (12.8%) and (9.2%). The mortality of hospital-acquired BSI was 27.6%. Multiple logistic regression analysis revealed that age [adjusted odds ratio (OR) = 1.06; 95% confidence interval (CI): 1.03, 1.09; < 0.001], cases with extended-spectrum beta-lactamases (ESBL) (adjusted OR = 5.57; 95% CI: 2.04, 15.21; = 0.001), with multidrug-resistant (MDR) organisms (adjusted OR = 14.70; 95% CI: 3.97, 54.48; < 0.001) and those with a sequential organ failure assessment (SOFA) score > 11 (adjusted OR = 4.16; 95% CI: 1.31, 13.19; = 0.015) had statistically significant associations with treatment failure. Factors significantly associated with 28-day mortality included age (adjusted OR: 1.06: 95% CI; 1.03, 1.09; < 0.001), MDR organisms (adjusted OR = 14.70; 95% CI: 3.97, 54.48; < 0.001) and SOFA score > 11 (adjusted OR = 4.16; 95% CI: 1.31, 13.19; = 0.015).
The elderly, ESBL, MDR organisms and high SOFA scores were associated with treatment failure and 28-day mortality in hospital-acquired BSI.
医院获得性血流感染（BSI）与高发病率和死亡率相关。本研究旨在描述马来西亚理科大学专科医院（HPUSM）重症监护病房医院获得性BSI的结局和预后，并确定28天治疗失败和死亡的相关因素。
这项前瞻性队列研究于2019年9月至2021年3月在HPUSM重症监护病房进行。符合条件的参与者包括入院48小时后血培养记录为阳性的患者。
共分离出250例血培养阳性患者。主要分离出的病原体为（23.6%）、 属（19.2%）、（12.8%）和（9.2%）。医院获得性BSI的死亡率为27.6%。多因素logistic回归分析显示，年龄[调整优势比（OR）=1.06；95%置信区间（CI）：1.03，1.09；<0.001]、产超广谱β-内酰胺酶（ESBL）病例（调整OR=5.57；95%CI：2.04，15.21；=0.001）、多重耐药（MDR）病原体（调整OR=14.70；95%CI：3.97，54.48；<0.001）以及序贯器官衰竭评估（SOFA）评分>11的患者（调整OR=4.16；95%CI：1.31，13.19；=0.015）与治疗失败有统计学显著关联。与28天死亡率显著相关的因素包括年龄（调整OR：1.06：95%CI；1.03，1.09；<0.001）、MDR病原体（调整OR=14.70；95%CI：3.97，54.48；<0.001）和SOFA评分>11（调整OR=4.16；95%CI：1.31，13.19；=0.015）。
老年人、ESBL、MDR病原体和高SOFA评分与医院获得性BSI的治疗失败和28天死亡率相关。
