Pant Praruj, Chihara Shingo, Krishnamoorthy Vijay, Treggiari Miriam M, Messina Julia A, Privratsky Jamie R, Raghunathan Karthik, Ohnuma Tetsu
Critical Care and Perioperative Population Health Research (CAPER) Program, Department of Anesthesiology, Duke University Medical Center, Durham, NC.
Section of Infectious Diseases, Department of Internal Medicine, Virginia Mason Medical Center, Seattle, WA.
Crit Care Explor. 2025 Feb 12;7(2):e1219. doi: 10.1097/CCE.0000000000001219. eCollection 2025 Feb 1.
The influence of disease-causing pathogen on acute kidney injury (AKI) in septic patients is poorly understood.
We examined the association of microbial pathogen with AKI among patients with community-onset sepsis.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study. Patient data were acquired from the nationwide multicenter PINC AI Healthcare Database (2016-2020). Participants included adult patients with Centers for Disease Control and Prevention-defined community-onset sepsis.
The primary exposure was pathogen type identified by culture growth. Microbial cultures from any site were included. The primary endpoint was development of AKI within 7 days of admission using the Kidney Disease: Improving Global Outcomes serum creatinine criteria. We used multilevel logistic regression to examine the association between pathogen type and AKI. Escherichia coli-positive cultures were used as the reference category.
We included 119,733 patients with community-onset sepsis. The median age was 67 years, 33.3% were mechanically ventilated, 36.1% received vasopressors, and hospital mortality was 13.1%. Forty-two thousand twenty-seven patients (35.1%) developed stage 1 AKI, 22,979 (19.2%) developed stage 2 AKI, and 25,073 (20.9%) developed stage 3 AKI. Relative to patients with E. coli infection (odds ratio [OR], 1.0), Proteus species (OR, 1.26; 95% CI, 1.06-1.50), and Streptococcus species (OR, 1.24; 95% CI, 1.10-1.41) were associated with increased odds of AKI. Meanwhile, Pseudomonas aeruginosa (OR, 0.56; 95% CI, 0.49-0.64) and Serratia species (OR, 0.70; 95% CI, 0.52-0.94) were associated with decreased odds of AKI.
The causative pathogen in patients with sepsis may influence the development of AKI. Further mechanistic and clinical research is needed to confirm these findings and to explore how different pathogens may affect AKI risk in critically ill patients.
致病病原体对脓毒症患者急性肾损伤（AKI）的影响尚不清楚。
我们研究了社区获得性脓毒症患者中微生物病原体与AKI之间的关联。
设计、背景和参与者：这是一项回顾性队列研究。患者数据来自全国多中心PINC AI医疗数据库（2016 - 2020年）。参与者包括疾病控制与预防中心定义的社区获得性脓毒症成年患者。
主要暴露因素是通过培养生长鉴定出的病原体类型。纳入任何部位的微生物培养结果。主要终点是根据改善全球肾脏病预后组织的血清肌酐标准，在入院7天内发生AKI。我们使用多水平逻辑回归分析病原体类型与AKI之间的关联。以大肠杆菌阳性培养结果作为参照类别。
我们纳入了119733例社区获得性脓毒症患者。中位年龄为67岁，33.3%接受机械通气，36.1%接受血管活性药物治疗，医院死亡率为13.1%。42027例患者（35.1%）发生1期AKI，22979例（19.2%）发生2期AKI，25073例（20.9%）发生3期AKI。与大肠杆菌感染患者相比（优势比[OR]为1.0），变形杆菌属（OR为1.26；95%置信区间为1.06 - 1.50）和链球菌属（OR为1.24；95%置信区间为1.10 - 1.41）与AKI发生风险增加相关。同时，铜绿假单胞菌（OR为0.56；95%置信区间为0.49 - 0.64）和沙雷菌属（OR为0.70；95%置信区间为0.52 - 0.
