Pittet D, Li N, Woolson R F, Wenzel R P
Division of General Medicine, Clinical Epidemiology and Health Services Research, University of Iowa College of Medicine, Iowa City, USA.
Clin Infect Dis. 1997 Jun;24(6):1068-78. doi: 10.1086/513640.
All patients (n = 1,745) with nosocomial bloodstream infection identified between 1986 and 1991 at a single 900-bed tertiary care hospital were studied to identify microbiological factors independently associated with mortality due to the infection. Patients were identified by prospective, case-based surveillance and positive blood cultures. Mortality rates were examined for secular trends. Prognostic factors were determined with use of univariate and multivariate analyses, and both derivation and validation sets were used. A total of 1,745 patients developed nosocomial bloodstream infection. The 28-day crude mortality was 22%, and crude in-hospital mortality was 35%. Factors independently (all P < .05) associated with increased 28-day mortality rates were older age, longer length of hospital stay before bloodstream infection, and a diagnosis of cancer or disease of the digestive system. After adjustment for major confounders, Candida species were the only organisms independently influencing the outcome of nosocomial bloodstream infection (odds ratio [OR] for mortality = 1.84; 95% confidence interval [CI], 1.22-2.76; P = .0035). The two additional microbiological factors independently associated with increased mortality were pneumonia as a source of secondary infection (OR = 2.74; 95% CI, 1.87-4.00; P < .0001) and polymicrobial infection (OR = 1.68; 95% CI, 1.22-2.32; P = .0014). Our data suggest that microbiological factors independently affect the outcome of nosocomial bloodstream infection.
对1986年至1991年间在一家拥有900张床位的三级护理医院确诊的所有1745例医院血流感染患者进行了研究，以确定与感染所致死亡独立相关的微生物学因素。通过前瞻性、基于病例的监测和血培养阳性来识别患者。检查死亡率的长期趋势。使用单变量和多变量分析确定预后因素，并使用推导集和验证集。共有1745例患者发生医院血流感染。28天粗死亡率为22%，住院粗死亡率为35%。与28天死亡率增加独立相关的因素（所有P<0.05）为年龄较大、血流感染前住院时间较长以及患有癌症或消化系统疾病。在对主要混杂因素进行调整后，念珠菌属是唯一独立影响医院血流感染结局的微生物（死亡率的比值比[OR]=1.84；95%置信区间[CI]，1.22-2.76；P=0.0035）。另外两个与死亡率增加独立相关的微生物学因素是作为继发感染源的肺炎（OR=2.74；95%CI，1.87-4.00；P<0.0001）和多微生物感染（OR=1.68；95%CI，1.22-2.32；P=0.0014）。我们的数据表明，微生物学因素独立影响医院血流感染的结局。
