Leibovici L, Drucker M, Konigsberger H, Samra Z, Harrari S, Ashkenazi S, Pitlik S D
Department of Medicine B, Beilinson Medical Center, Petah-Tikva, Israel.
Scand J Infect Dis. 1997;29(1):71-5. doi: 10.3109/00365549709008668.
Of 4,289 episodes of bacteremia detected in 3,631 patients, septic shock was diagnosed in 453 episodes (10.5%). In 56% of shock episodes, septic shock developed more than 24 h after the first positive blood culture was taken. In a logistic regression analysis, variables predictive of septic shock were: advanced age [odds ratio (OR) of 1.015 for an increment of 1 year]; renal failure as an underlying disorder (OR = 1.47); neutropenia (OR of 2.26); curtailed functional capacity (OR of 1.54 for an increment of 1 category); unknown source of infection (OR = 1.66); anaerobic (OR = 2.86), polymicrobial bacteremia (OR = 1.54), or pathogens other than Streptococcus viridans (OR = 0.08 for Streptococcus viridans). The in-hospital mortality associated with septic shock was 80% vs 21% in episodes of bacteremia without shock, and shock episodes accounted for 31% of all deaths. The fatality rate in shock patients given appropriate empiric antibiotic treatment was 74.9% vs 84.7% in patients given inappropriate treatment (p = 0.01). Judging by the present results, host factors are more important determinants for development of septic shock in bacteremic patients than the type of pathogen. Even in patients with shock, appropriate empiric antibiotic treatment was associated with an improved chance of survival.
在3631例患者中检测到4289次菌血症发作，其中453次发作（10.5%）被诊断为感染性休克。在56%的休克发作中，感染性休克在首次血培养阳性后24小时以上出现。在逻辑回归分析中，感染性休克的预测变量为：高龄（每增加1岁，比值比[OR]为1.015）；作为基础疾病的肾衰竭（OR = 1.47）；中性粒细胞减少（OR为2.26）；功能能力受限（每增加1个类别，OR为1.54）；感染源不明（OR = 1.66）；厌氧菌（OR = 2.86）、多微生物菌血症（OR = 1.54）或除草绿色链球菌外的其他病原体（草绿色链球菌的OR = 0.08）。与感染性休克相关的院内死亡率为80%，而无休克的菌血症发作的死亡率为21%，休克发作占所有死亡人数的31%。给予适当经验性抗生素治疗的休克患者的死亡率为74.9%，而给予不适当治疗的患者为84.7%（p = 0.01）。根据目前的结果判断，宿主因素比病原体类型更重要，是菌血症患者发生感染性休克的决定因素。即使在休克患者中，适当的经验性抗生素治疗也与提高生存机会相关。
