Chen S C, Lawrence R H, Byth K, Sorrell T C
Centre for Infectious Diseases and Microbiology, University of Sydney, NSW.
Med J Aust. 1993 Nov 1;159(9):592-7.
To review changes in the epidemiology, course, and outcome of bacteraemia caused by Pseudomonas aeruginosa.
A retrospective, descriptive study of consecutive cases of P. aeruginosa bacteraemia occurring at a university teaching hospital.
Between January 1980 and December 1989, 164 patients were admitted to Westmead Hospital with P. aeruginosa bacteraemia. Patients in whom there was no clinical evidence of sepsis were excluded from analysis leaving a cohort of 152 patients. Hospital records were reviewed and details of demography, clinical features, therapy, and outcome were recorded.
One hundred and fifty-five episodes of P. aeruginosa bacteraemia were recorded at an average rate of 0.39 per 1000 admissions per year. The respiratory and pancreatobiliary tracts were the most common sources of the bacteraemia. Pancreatobiliary disease, independent of an underlying malignancy or immunosuppression, emerged as a previously undescribed risk factor for pseudomonal bacteraemia (incidence of 3.0 episodes per 1000 hospital admissions for patients with this disease). The crude mortality rate was 52%; 35% was attributable to pseudomonal bacteraemia. Factors identified as being independently associated with an increased mortality included hypotension, age of 60 years or older, and the presence of an underlying malignancy. Combination therapy with an antipseudomonal penicillin and an aminoglycoside confers a significant survival advantage independent of underlying neutropenia.
Bacteraemia caused by P. aeruginosa remains an important cause of morbidity and mortality. Pancreatobiliary disease represents a new risk factor for P. aeruginosa bacteraemia, independent of an underlying malignancy or immunosuppression. It may be prudent to consider P. aeruginosa as a cause of sepsis in these circumstances, especially if there has been instrumentation of the biliary tree. Hypotension, age of 60 years or older, and the presence of an underlying malignancy were independently associated with significantly increased mortality. Appropriate antibiotic therapy consisting of an antipseudomonal beta-lactam in addition to an aminoglycoside resulted in a significant decrease in mortality compared with the use of an aminoglycoside alone, not only in the study population as a whole, but also in patients without neutropenia.
回顾铜绿假单胞菌所致菌血症的流行病学、病程及转归的变化。
对一所大学教学医院连续发生的铜绿假单胞菌菌血症病例进行回顾性描述性研究。
1980年1月至1989年12月期间，164例因铜绿假单胞菌菌血症入住韦斯特米德医院的患者。无败血症临床证据的患者被排除在分析之外，最终纳入152例患者。查阅医院记录，记录人口统计学、临床特征、治疗及转归的详细信息。
共记录到155次铜绿假单胞菌菌血症发作，平均每年每1000例入院患者中有0.39次发作。呼吸道和胰胆管是菌血症最常见的来源。胰胆管疾病，独立于潜在恶性肿瘤或免疫抑制，成为铜绿假单胞菌菌血症一个此前未描述的危险因素（该病患者每1000例住院患者中发作率为3.0次）。粗死亡率为52%；35%可归因于铜绿假单胞菌菌血症。被确定与死亡率增加独立相关的因素包括低血压、年龄60岁及以上以及存在潜在恶性肿瘤。抗假单胞菌青霉素与氨基糖苷类联合治疗，无论是否存在潜在中性粒细胞减少，均能带来显著的生存优势。
铜绿假单胞菌所致菌血症仍然是发病和死亡的重要原因。胰胆管疾病是铜绿假单胞菌菌血症的一个新危险因素，独立于潜在恶性肿瘤或免疫抑制。在这些情况下，尤其是如果有胆管树器械操作时，将铜绿假单胞菌视为败血症的病因可能是谨慎的做法。低血压、年龄60岁及以上以及存在潜在恶性肿瘤与死亡率显著增加独立相关。与单独使用氨基糖苷类相比，由抗假单胞菌β-内酰胺类联合氨基糖苷类组成的适当抗生素治疗可使死亡率显著降低，不仅在整个研究人群中如此，在无中性粒细胞减少的患者中也是如此。
