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真性菌血症的预测因素。

Predictors for true bacteraemia.

作者信息

Sharma Mamta, Szpunar Susan, Tanveer Farah, Arcobello Jonathan, Revankar Sanjay, Bhargava Ashish

机构信息

Division of Infectious Disease, Henry Ford St John Hospital, Detroit, Michigan, USA.

Department of Biomedical Investigations and Research, Detroit, Michigan, USA.

出版信息

J Med Microbiol. 2025 Jun;74(6). doi: 10.1099/jmm.0.002026.

Abstract

species colonizing the human oropharynx and gastrointestinal and urogenital tract are associated with a wide range of infections. The isolation of spp. from sterile clinical samples is regarded as significant. Increased use of advanced diagnostics has caused an increased detection of in the bloodstream, the clinical significance of which is unclear. To investigate the clinical factors associated with true bacteraemia that could aid in differentiating it from transient bacteraemia. We conducted a retrospective study of all inpatients with bacteraemia from two tertiary care centres from 1 January 2006 to 26 September 2021. Data were collected on demographic and clinical characteristics, comorbidities, primary source of infection and outcomes. True bacteraemia was defined as bacteraemia with systemic manifestations of infection. A total of 82 cases of positive blood cultures were identified, of which 33 (40.2%) were true bacteraemia, based on clinical criteria. Patients with true bacteraemia were more likely to be older (=0.007), have chronic skin ulcers (<0.001), have a history of central line placement within 3 months of their presentation (=0.04), have had a fever within 72 h of admission (=0.05) and have presented with an abscess (<0.001) compared with patients with transient bacteraemia. True bacteraemia was more likely to be associated with positive tissue cultures (=0.02) and an infectious disease consultation than transient bacteraemia. Skin and soft tissue (27.3%) was the most common source followed by intra-abdominal (21.1%). Among true bacteraemia, the most common species was with a ratio of 1:8 (transient versus true bacteraemia). All-cause mortality was 30.3% in patients with true bacteraemia compared with 4.1% in patients with transient bacteraemia (<0.001). Predictors of true bacteraemia included older age, fever within 72 h of admission, presence of abscess and chronic skin disease. species exhibit varying degrees of invasiveness, with potentially showing higher invasive potential. Better awareness and involvement of infectious disease specialists is recommended in determining the clinical significance of transient bacteraemia and can help implement antibiotic stewardship and patient safety and improve outcomes. Further research will help to identify the true importance of these isolates.

摘要

定植于人类口咽、胃肠道和泌尿生殖道的菌种与多种感染相关。从无菌临床样本中分离出[具体菌种]被视为具有重要意义。先进诊断方法使用的增加导致血液中[具体菌种]检测率上升,但其临床意义尚不清楚。为了研究与真正的[具体菌种]菌血症相关的临床因素,以助于将其与短暂性[具体菌种]菌血症区分开来。我们对2006年1月1日至2021年9月26日期间来自两个三级医疗中心的所有[具体菌种]菌血症住院患者进行了一项回顾性研究。收集了人口统计学和临床特征、合并症、感染的主要来源及结局等数据。真正的菌血症被定义为伴有感染全身表现的[具体菌种]菌血症。根据临床标准,共鉴定出82例血培养阳性病例,其中33例(40.2%)为真正的菌血症。与短暂性菌血症患者相比,真正菌血症患者更可能年龄较大(P = 0.007)、患有慢性皮肤溃疡(P < 0.001)、在就诊前3个月内有中心静脉置管史(P = 0.04)、入院72小时内发热(P = 0.05)以及出现脓肿(P < 0.001)。与短暂性菌血症相比,真正的菌血症更可能与组织培养阳性(P = 0.02)和感染病会诊相关。皮肤和软组织(27.3%)是最常见的感染源,其次是腹腔内(21.1%)。在真正的菌血症中,最常见的菌种是[具体菌种],其比例为1:8(短暂性菌血症与真正菌血症之比)。真正菌血症患者的全因死亡率为30.3%,而短暂性菌血症患者为4.1%(P < 0.001)。真正的[具体菌种]菌血症的预测因素包括年龄较大、入院72小时内发热、存在脓肿和慢性皮肤病。[具体菌种]表现出不同程度的侵袭性,[具体菌种]可能具有更高的侵袭潜力。建议在确定短暂性[具体菌种]菌血症的临床意义时,感染病专家要有更高的认识并参与其中,这有助于实施抗生素管理和保障患者安全并改善结局。进一步的研究将有助于确定这些分离株的真正重要性。

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