Crowe M, Ispahani P, Humphreys H, Kelley T, Winter R
Division of Microbiology and Infectious Diseases, Queen's Medical Centre, Nottingham, UK.
Eur J Clin Microbiol Infect Dis. 1998 Jun;17(6):377-84. doi: 10.1007/BF01691564.
Bacteraemia is an important cause of morbidity and mortality in the intensive care unit. In this study the distribution of organisms causing bacteraemic episodes in patients in the adult intensive care unit of a large teaching hospital was determined. Particular emphasis was placed on the type of organisms isolated from community- and hospital-acquired bacteraemia, the suspected source of infection, the possible risk factors associated with bacteraemia, and outcome. The incidence of bacteraemia and fungaemia increased from 17.7 per 1000 admissions in 1985 to 80.3 in 1996. A total of 315 episodes of bacteraemia and fungaemia were documented over a 12-year period, of which 18% were considered community-acquired and 82% hospital-acquired. Gram-positive and gram-negative bacteria accounted for 46.9% and 31.5% of the episodes, respectively. Polymicrobial infection accounted for 17.8% and fungi for 3.8% of the episodes. Staphylococcus aureus (22.5%), Staphylococcus epidermidis (7.6%), and Streptococcus pneumoniae (7.9%) were the predominant gram-positive bacteria implicated, whereas Escherichia coli (6%), Enterobacter cloacae (7%), Klebsiella aerogenes (3.8%), Pseudomonas aeruginosa (5.1%), and Acinetobacter spp. (3.8%) were the predominant gram-negative bacteria isolated. The two most common sources of infection were the respiratory tract (39.7%) and an intravascular line (24.5%), but in 8.9% of episodes the focus of infection remained unknown. Bacteraemic patients stayed in the unit for a longer period (12 days) than did non-bacteraemic patients (3 days). The overall mortality related to bacteraemia and candidaemia was 44.4%. Surveillance of bacteraemia in the intensive care unit is important in detecting major changes in aetiology, e.g., the increasing incidence of gram-positive bacteraemia, the emergence of methicillin-resistant Staphylococcus aureus in 1995, and the emergence of Enterobacter cloacae. It is of value in determining empirical antimicrobial therapy to treat presumed infection pending a microbiological diagnosis and in directing the development of guidelines for infection prevention, e.g., guidelines for central venous catheter care.
菌血症是重症监护病房发病和死亡的重要原因。在本研究中，确定了一家大型教学医院成人重症监护病房患者菌血症发作的病原体分布情况。特别强调了从社区获得性和医院获得性菌血症中分离出的病原体类型、可疑感染源、与菌血症相关的可能危险因素以及结局。菌血症和真菌血症的发病率从1985年每1000例入院患者中的17.7例增加到1996年的80.3例。在12年期间共记录了315例菌血症和真菌血症发作，其中18%被认为是社区获得性的，82%是医院获得性的。革兰氏阳性菌和革兰氏阴性菌分别占发作病例的46.9%和31.5%。混合菌感染占发作病例的17.8%，真菌占3.8%。金黄色葡萄球菌（22.5%）、表皮葡萄球菌（7.6%）和肺炎链球菌（7.9%）是主要的革兰氏阳性菌，而大肠杆菌（6%）、阴沟肠杆菌（7%）、产气克雷伯菌（3.8%）、铜绿假单胞菌（5.1%）和不动杆菌属（3.8%）是主要分离出的革兰氏阴性菌。两个最常见的感染源是呼吸道（39.7%）和血管内导管（24.5%），但在8.9%的发作病例中感染灶仍不明。菌血症患者在病房的停留时间（12天）比非菌血症患者（3天）更长。与菌血症和念珠菌血症相关的总体死亡率为44.4%。重症监护病房的菌血症监测对于发现病因学的重大变化很重要，例如革兰氏阳性菌血症发病率的增加、1995年耐甲氧西林金黄色葡萄球菌的出现以及阴沟肠杆菌的出现。这对于在微生物诊断之前确定治疗假定感染的经验性抗菌治疗以及指导制定感染预防指南（如中心静脉导管护理指南）具有重要价值。
