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Abstract：
BACKGROUND: Polymicrobial bloodstream infections (BSI) are difficult to treat since empiric antibiotics treatment are frequently less effective against multiple pathogens. The study aimed to compare outcomes in patients with polymicrobial and monomicrobial BSIs.
METHODS: The study was a retrospective case-control design conducted at Muhimbili National Hospital for data processed between July 2021 and June 2022. Cases were patients with polymicrobial BSI, and controls had monomicrobial BSI. Each case was matched to three controls by age, admitting ward, and duration of admission. Logistic regression was performed to determine independent risk factors for in-hospital and 30-day mortality.
RESULTS: Fifty patients with polymicrobial BSI and 150 with monomicrobial BSI were compared: the two arms had no significant differences in sex and comorbidities. The most frequent bacteria in polymicrobial BSI were Klebsiella pneumoniae 17% (17/100) and Enterobacter species 15% (15/100). In monomicrobial BSI, S. aureus 17.33% (26/150), Klebsiella pneumoniae 16.67% (25/150), and Acinetobacter species 15% (15/150) were more prevalent. Overall, isolates were frequently resistant to multiple antibiotics tested, and 52% (130/250) were multidrug resistance. The 30-day and in-hospital mortality were 33.5% (67/200) and 36% (72/200), respectively. On multivariable analysis, polymicrobial BSIs were independent risk factors for both in-hospital mortality (aOR 2.37, 95%CI 1.20-4.69, p = 0.01) and 30-day mortality (aOR 2.05, 95%CI 1.03-4.08), p = 0.04). In sub-analyses involving only neonates, polymicrobial BSI was an independent risk factor for both 30-day mortality (aOR 3.13, 95%CI 1.07-9.10, p = 0.04) and in-hospital mortality (aOR 5.08, 95%CI 1.60-16.14, p = 0.006). Overall, the median length of hospital stay post-BSIs was numerically longer in patients with polymicrobial BSIs.
CONCLUSIONS: Overall, polymicrobial BSI was a significant risk for mortality. Patients with polymicrobial BSI stay longer at the hospital than those with monomicrobial BSI. These findings call for clinicians to be more aggressive in managing polymicrobial BSI.
METHODS: The study was a retrospective case-control design conducted at Muhimbili National Hospital for data processed between July 2021 and June 2022. Cases were patients with polymicrobial BSI, and controls had monomicrobial BSI. Each case was matched to three controls by age, admitting ward, and duration of admission. Logistic regression was performed to determine independent risk factors for in-hospital and 30-day mortality.
RESULTS: Fifty patients with polymicrobial BSI and 150 with monomicrobial BSI were compared: the two arms had no significant differences in sex and comorbidities. The most frequent bacteria in polymicrobial BSI were Klebsiella pneumoniae 17% (17/100) and Enterobacter species 15% (15/100). In monomicrobial BSI, S. aureus 17.33% (26/150), Klebsiella pneumoniae 16.67% (25/150), and Acinetobacter species 15% (15/150) were more prevalent. Overall, isolates were frequently resistant to multiple antibiotics tested, and 52% (130/250) were multidrug resistance. The 30-day and in-hospital mortality were 33.5% (67/200) and 36% (72/200), respectively. On multivariable analysis, polymicrobial BSIs were independent risk factors for both in-hospital mortality (aOR 2.37, 95%CI 1.20-4.69, p = 0.01) and 30-day mortality (aOR 2.05, 95%CI 1.03-4.08), p = 0.04). In sub-analyses involving only neonates, polymicrobial BSI was an independent risk factor for both 30-day mortality (aOR 3.13, 95%CI 1.07-9.10, p = 0.04) and in-hospital mortality (aOR 5.08, 95%CI 1.60-16.14, p = 0.006). Overall, the median length of hospital stay post-BSIs was numerically longer in patients with polymicrobial BSIs.
CONCLUSIONS: Overall, polymicrobial BSI was a significant risk for mortality. Patients with polymicrobial BSI stay longer at the hospital than those with monomicrobial BSI. These findings call for clinicians to be more aggressive in managing polymicrobial BSI.
摘要：
背景:多微生物血流感染(BSI)难以治疗,因为经验性抗生素治疗通常对多种病原体不太有效。该研究旨在比较多微生物和单抗微生物BSIs患者的预后。
方法：该研究是在Muhimbili国立医院进行的回顾性病例对照设计，用于处理2021年7月至2022年6月之间的数据。病例为多微生物BSI患者，和对照组有单抗微生物BSI。每个病例按年龄与三个对照相匹配，入院病房,和入场时间。进行Logistic回归以确定住院和30天死亡率的独立危险因素。
结果：比较了50例多微生物BSI患者和150例单抗微生物BSI患者：两组在性别和合并症方面没有显着差异。多微生物BSI中最常见的细菌是肺炎克雷伯菌17％（17/100）和肠杆菌15％（15/100）。在单抗微生物BSI中，金黄色葡萄球菌17.33%（26/150），肺炎克雷伯菌16.67%(25/150),不动杆菌属15％（15/150）更为普遍。总的来说,分离株经常对测试的多种抗生素具有耐药性，52％（130/250）是多药耐药。30天和住院死亡率分别为33.5％（67/200）和36％（72/200），分别。在多变量分析中，多微生物BSI是院内死亡率（aOR2.37，95CI1.20-4.69，p=0.01）和30天死亡率（aOR2.05，95CI1.03-4.08）的独立危险因素，p=0.04)。在仅涉及新生儿的子分析中，多微生物BSI是30天死亡率(aOR3.13,95CI1.07-9.10,p=0.04)和院内死亡率(aOR5.08,95CI1.60-16.14,p=0.006)的独立危险因素.总的来说,在接受多微生物BSI的患者中,BSI后的中位住院时间在数值上更长.
结论：总体而言，多微生物BSI是死亡的显著风险.具有多微生物BSI的患者比具有单微生物BSI的患者在医院停留的时间更长。这些发现要求临床医生更积极地管理多微生物BSI。
方法：该研究是在Muhimbili国立医院进行的回顾性病例对照设计，用于处理2021年7月至2022年6月之间的数据。病例为多微生物BSI患者，和对照组有单抗微生物BSI。每个病例按年龄与三个对照相匹配，入院病房,和入场时间。进行Logistic回归以确定住院和30天死亡率的独立危险因素。
结果：比较了50例多微生物BSI患者和150例单抗微生物BSI患者：两组在性别和合并症方面没有显着差异。多微生物BSI中最常见的细菌是肺炎克雷伯菌17％（17/100）和肠杆菌15％（15/100）。在单抗微生物BSI中，金黄色葡萄球菌17.33%（26/150），肺炎克雷伯菌16.67%(25/150),不动杆菌属15％（15/150）更为普遍。总的来说,分离株经常对测试的多种抗生素具有耐药性，52％（130/250）是多药耐药。30天和住院死亡率分别为33.5％（67/200）和36％（72/200），分别。在多变量分析中，多微生物BSI是院内死亡率（aOR2.37，95CI1.20-4.69，p=0.01）和30天死亡率（aOR2.05，95CI1.03-4.08）的独立危险因素，p=0.04)。在仅涉及新生儿的子分析中，多微生物BSI是30天死亡率(aOR3.13,95CI1.07-9.10,p=0.04)和院内死亡率(aOR5.08,95CI1.60-16.14,p=0.006)的独立危险因素.总的来说,在接受多微生物BSI的患者中,BSI后的中位住院时间在数值上更长.
结论：总体而言，多微生物BSI是死亡的显著风险.具有多微生物BSI的患者比具有单微生物BSI的患者在医院停留的时间更长。这些发现要求临床医生更积极地管理多微生物BSI。
