Abstract：
Despite a low incidence, anaerobic bacteremia remains a serious and often underestimated condition. This retrospective study aims to describe the epidemiology of anaerobic bacteremia and to identify risk factors affecting mortality and the impact of treatment. We included all positive anaerobic blood cultures from January 2018 to December 2019 at the University Hospital of Charleroi (Belgium). We identified 105 episodes of clinically significant anaerobic bacteremia (mean age of patients: 66.4 +/- 16.8 years). The main comorbidities were hypertension, chronic kidney disease, and diabetes. Bacteremia was community-acquired in 70.5% of the episodes. Two thirds of the blood cultures were mono-microbial, and the commonest bacteria found were Bacteroides fragilis group (31.4%), Fusobacterium spp. (17.1%) and Clostridium spp. (15.2%). The main sources of bacteremia were abdominal (35.2%), urinary (17.1%), osteoarticular (14.2%) and pulmonary (12.3%). Surgery within 30 days before hospitalization was more frequent in patients with nosocomial bacteremia (45.2% vs 2.7%, p < 0.0001). An appropriate empirical antibiotic therapy was initiated in 74.7% of patients, and the median duration of antibiotic therapy was 10 [5 - 15] days. One third of patients had a surgical management. Patients who did not survive at day 30 (n = 23 [21.9%]) had significantly lower time to positivity (TTP) values than patients alive at day 30, presented more often with sepsis, had higher Charlson scores and chronic kidney disease, and were more likely to suffer from Clostridium spp. bacteremia. In a Cox proportional hazard analysis, sepsis (OR: 7.32 [95% CI: 2.83- 18.97], p< 0.0001) was identified as an independent risk factors for 30-day mortality, whereas time to positivity ≥ 30 h (OR: 0.24 [95% CI: 0.07 - 0.84], p = 0.025) and an adequate empirical antibiotic therapy (OR: 0.37 [95% CI: 0.15 - 0.94], p = 0.037) were associated with better outcomes. Anaerobic bacteremia has a high mortality rate which justifies the maintenance of empirical antibiotic therapy.
摘要：
尽管发病率低,厌氧性菌血症仍然是一种严重且经常被低估的疾病。这项回顾性研究旨在描述厌氧菌血症的流行病学，并确定影响死亡率和治疗影响的危险因素。我们纳入了沙勒罗瓦大学医院（比利时）2018年1月至2019年12月的所有阳性厌氧血液培养物。我们确定了105例有临床意义的厌氧性菌血症（患者的平均年龄：66.4/-16.8岁）。主要的合并症是高血压，慢性肾病,和糖尿病。在70.5％的发作中，菌血症是社区获得的。三分之二的血培养是单一微生物，发现的最常见的细菌是脆弱拟杆菌组(31.4%)，梭杆菌属。（17.1%）和梭菌属。（15.2%）。菌血症的主要来源是腹部(35.2%),尿（17.1%），骨关节（14.2%）和肺（12.3%）。住院前30天内的手术在医院内菌血症患者中更为频繁（45.2％vs2.7％，p<0.0001)。74.7%的患者开始了适当的经验性抗生素治疗，抗生素治疗的中位持续时间为10[5-15]天。三分之一的患者接受了手术治疗。在第30天没有存活的患者（n=23[21.9%]）的阳性时间（TTP）值明显低于在第30天存活的患者，更常出现败血症。有更高的Charlson分数和慢性肾病，并且更有可能患有梭菌。菌血症.在Cox比例风险分析中，脓毒症（OR：7.32[95%CI：2.83-18.97]，p<0.0001)被确定为30天死亡率的独立危险因素，而阳性时间≥30小时(OR：0.24[95%CI：0.07-0.84]，p=0.025）和足够的经验性抗生素治疗（OR：0.37[95%CI：0.15-0.94]，p=0.037）与更好的结果相关。无氧菌血症的死亡率很高，这证明了维持经验性抗生素治疗的合理性。
