Maslow J N, Mulligan M E, Adams K S, Justis J C, Arbeit R D
Infectious Diseases Section, VA Medical Center, Boston, Massachusetts 02130.
Clin Infect Dis. 1993 Jul;17(1):89-97. doi: 10.1093/clinids/17.1.89.
To assess the contributions of bacterial virulence factors and defects in host defense to Escherichia coli bacteremia, we examined isolates and available medical records from 169 episodes at two hospitals. Adhesins and hemolysin virulence factors were documented in 84% of bacteremia-associated isolates originating from the urinary and respiratory tracts and in 50% of such isolates originating from other extraurinary foci. Of the evaluable episodes of bacteremia involving 35 adhesin-negative isolates, 21 (60%) were in patients who had mucocutaneous defects at the primary site of infection, and another 13 (37%) were in patients who had comorbid systemic diseases (i.e., chronic renal failure or alcoholism) associated with impaired leukocyte function. In contrast, of 93 evaluable episodes with adhesin-positive isolates, 22 (24%) were in patients who had none of these host conditions (P = .008). Overall, of evaluable episodes of bacteremia involving 128 isolates, 71 (55%) had both bacterial virulence-associated and host-related risk factors. Mortality was related to the severity of comorbid illnesses and was not affected by the presence of the bacterial virulence factors assessed.
为评估细菌毒力因子及宿主防御缺陷对大肠杆菌菌血症的影响，我们检查了两家医院169例病例的分离菌株及现有病历。尿路和呼吸道来源的与菌血症相关的分离菌株中，84%记录有黏附素和溶血素毒力因子，其他非尿路病灶来源的此类菌株中，这一比例为50%。在35株黏附素阴性分离菌株的可评估菌血症病例中，21例（60%）患者在感染原发部位有黏膜皮肤缺损，另外13例（37%）患者患有与白细胞功能受损相关的合并全身性疾病（即慢性肾衰竭或酗酒）。相比之下，在93例黏附素阳性分离菌株的可评估病例中，22例（24%）患者无上述任何宿主状况（P = 0.008）。总体而言，在128株分离菌株的可评估菌血症病例中，71例（55%）同时存在细菌毒力相关和宿主相关危险因素。死亡率与合并疾病的严重程度相关，不受所评估的细菌毒力因子存在与否的影响。
