Leibovici L, Samra Z, Konigsberger H, Drucker M, Ashkenazi S, Pitlik S D
Department of Medicine B, Beilinson Medical Center, Petah Tiqva, Israel.
JAMA. 1995 Sep 13;274(10):807-12.
To delineate long-term survival after an episode of bacteremia or fungemia and risk factors for mortality.
Cohort study.
A 900-bed university hospital in Israel.
Study group comprising 1991 patients 18 years of age or older in whom bacteremia or fungemia were detected between March 1988 and October 1992, and a control group comprising 1991 inpatients without any infectious diseases, matched for age, sex, department, date of admission, and underlying disorders.
None.
Interval from the date of the first positive blood culture (study group) or from date of the identical hospital day (in the matched control patient) to the date of death as recorded in the Israeli National Population registry or, if alive, to June 1, 1994.
The median age of patients was 72 years. In the study group, the mortality rate was 26% at 1 month, 43% at 6 months, 48% at 1 year, and 63% at 4 years, and the median survival was 16.2 months. In the control group, the mortality rate was 7% at 1 month, 27% at 1 year, and 42% at 4 years, and the median survival was greater than 75 months (P < .001). Factors significantly and independently associated with mortality in bacteremic patients were functional class (median survival, 0.5 month in bedridden patients), septic shock (median survival, 0.2 month), serum albumin (median survival, 1.1 months in the lowest quartile), serum creatinine (median survival, 2.9 months in the highest quartile), age (median survival, 2.9 months in the highest quartile [age > 80 years]), inappropriate empirical antibiotic treatment (median survival, 4.9 months), nosocomial infection (median survival, 9.6 months), and malignancy (median survival, 2.4 months).
Bacteremia is associated with high short-term mortality, but also a sign of severely curtailed long-term prognosis, especially in patients with low functional capacity, low serum albumin, high serum creatinine, nosocomial infections, malignancy, inappropriate antimicrobial treatment, and septic shock and in elderly patients.
描述菌血症或真菌血症发作后的长期生存率及死亡危险因素。
队列研究。
以色列一家拥有900张床位的大学医院。
研究组包括1991例18岁及以上患者，于1988年3月至1992年10月期间检测到菌血症或真菌血症；对照组包括1991例无任何传染病的住院患者，按年龄、性别、科室、入院日期和基础疾病进行匹配。
无。
从首次血培养阳性日期（研究组）或同一住院日（匹配的对照患者）至以色列国家人口登记处记录的死亡日期，若仍存活则至1994年6月1日。
患者的中位年龄为72岁。在研究组中，1个月时死亡率为26%，6个月时为43%，1年时为48%，4年时为63%，中位生存期为16.2个月。在对照组中，1个月时死亡率为7%，1年时为27%，4年时为42%，中位生存期大于75个月（P<0.001）。菌血症患者中与死亡显著且独立相关的因素包括功能分级（卧床患者中位生存期为0.5个月）、感染性休克（中位生存期为0.2个月）、血清白蛋白（最低四分位数中位生存期为1.1个月）、血清肌酐（最高四分位数中位生存期为2.9个月）、年龄（最高四分位数[年龄>80岁]中位生存期为2.9个月）、经验性抗生素治疗不当（中位生存期为4.9个月）、医院感染（中位生存期为9.6个月）和恶性肿瘤（中位生存期为2.4个月）。
菌血症与短期高死亡率相关，也是长期预后严重缩短的标志，尤其是在功能能力低下、血清白蛋白低、血清肌酐高、医院感染、恶性肿瘤、抗菌治疗不当、感染性休克的患者以及老年患者中。
