Bryan C S, Reynolds K L, Brenner E R
Rev Infect Dis. 1983 Jul-Aug;5(4):629-38. doi: 10.1093/clinids/5.4.629.
Over the five-year period 1977-1981, we studied 1,186 episodes of bacteremia due to Enterobacteriaceae and Pseudomonadaceae in the four non-university hospitals of a single metropolitan area. Overall patient mortality was 36.3%, and mortality attributed specifically to infection was 19.0%. The importance of severity of underlying disease, site of infection, microorganism, and age--previously determined to be prognostic factors in studies conducted at tertiary-care centers--was confirmed. Appropriate initial antimicrobial therapy (defined as the administration of an effective agent in adequate dose and by a suitable route of administration on the first calendar day on which blood cultures were positive) did not improve survival compared with the use of an ineffective antimicrobial agent or no therapy at all. However, appropriate antimicrobial therapy subsequent to the first calendar day on which blood cultures were positive clearly affected survival. These findings confirm previous conclusions regarding the frequency and severity of gram-negative bacteremia and the overall impact of antimicrobial therapy on this condition. These studies also suggest the possibility that the definition of optimal initial therapy in some groups of patients should be reconsidered.
在1977年至1981年的五年期间，我们对一个大都市地区四家非大学医院中由肠杆菌科和假单胞菌科引起的1186例菌血症病例进行了研究。患者总体死亡率为36.3%，因感染导致的死亡率为19.0%。先前在三级医疗中心进行的研究中确定的基础疾病严重程度、感染部位、微生物和年龄作为预后因素的重要性得到了证实。与使用无效抗菌药物或根本不进行治疗相比，适当的初始抗菌治疗（定义为在血培养呈阳性的第一个日历日给予有效药物且剂量充足、给药途径合适）并未提高生存率。然而，在血培养呈阳性的第一个日历日之后进行适当的抗菌治疗明显影响了生存率。这些发现证实了先前关于革兰氏阴性菌血症的频率和严重程度以及抗菌治疗对这种疾病总体影响的结论。这些研究还表明，在某些患者群体中，最佳初始治疗的定义可能需要重新考虑。
