PDF(Pubmed)
Abstract：
This study evaluated the determinants of mortality and the T cell immune response in patients with persistent Staphylococcus aureus bacteremia (SAB). This was a prospective cohort study and patients with confirmed SAB were enrolled from 2008 to 2020. We compared clinical, microbiological, and genotypic features between surviving and deceased patients with persistent SAB. The concentrations of cytokines and the proportions of IFN-γ secreting CD4+ T cells were measured serially during the bacteremia period. Of the 1760 patients, 242 had persistent bacteremia (PB), and 49 PB patients died within 30 days. In the multivariate analysis, the APACHE II score and female sex were independently associated with 30 days mortality. The level of IL-10 was significantly increased in the plasma of patients with a high Pitt bacteremia score and those who died within 12 weeks from the index day. The proportion of IFN-γ-secreting CD4+ T cells were the highest just before the positive-to-negative conversion of blood cultures in patients with a low Pitt bacteremia score and those who survived for 12 weeks. The level of IL-10 is correlated with clinical outcomes in PB patients. IFN-γ secreting CD4+ T cells might play a pivotal role in SAB PB.
摘要：
这项研究评估了持续性金黄色葡萄球菌菌血症（SAB）患者死亡率和T细胞免疫反应的决定因素。这是一项前瞻性队列研究，2008年至2020年纳入确诊为SAB的患者。我们比较了临床，微生物,以及持续性SAB存活和死亡患者的基因型特征。在菌血症期间连续测量细胞因子的浓度和分泌IFN-γ的CD4T细胞的比例。在1760名患者中，242有持续性菌血症（PB），49例PB患者在30天内死亡。在多变量分析中，APACHEII评分和女性性别与30日死亡率独立相关.具有高Pitt菌血症评分的患者和从指数日起12周内死亡的患者的血浆中IL-10水平显着增加。在Pitt菌血症评分较低的患者和存活12周的患者中，在血培养阳性至阴性转化之前，分泌IFN-γ的CD4T细胞的比例最高。IL-10水平与PB患者的临床预后相关。分泌IFN-γ的CD4+T细胞可能在SABPB中起关键作用。
