目的:尽管脓肿病变在厌氧菌血症(AB)的临床决策中很重要,它们对临床特征的影响尚不清楚.在这里,我们旨在阐明与AB相关的临床因素,这些因素在感染初期未伴有可检测到的脓肿病变.
方法:这是一项多中心回顾性观察研究,涉及2012年1月至2022年3月在日本六家三级医院进行的经培养证实的AB患者。临床特征数据,收集了实验室和放射学发现,并分析了它们与没有可检测到的脓肿病变的关联。
结果:总计,包括393名参与者。整个队列的42.7%没有脓肿病变,其余患者均可检测到。在恶性肿瘤中没有发现差异,严重程度,或有和没有可检测到的脓肿病变的患者之间的30天死亡率。调整年龄和改良Charlson合并症评分的多变量logistic回归分析显示免疫抑制状态(发热性中性粒细胞减少或使用皮质类固醇),C反应蛋白(CRP)水平在发病时≤9.8mg/dL,革兰阳性厌氧棒(GPARs)的存在与AB独立相关,未伴有可检测到的脓肿病变[比值比(ORs)分别为3.24、3.00和2.81;p<0.05].
结论:这项研究阐明了AB的独特的临床和微生物学特征,没有伴有可检测的脓肿病变,CRP升高相对较低,免疫抑制状态,和GPAR作为致病厌氧菌。
OBJECTIVE: Despite the importance of abscess lesions in clinical decisions regarding anaerobic bacteremia (AB), their impact on clinical characteristics remains unclear. Herein, we aimed to elucidate the clinical factors associated with AB that were unaccompanied by detectable abscess lesions during the initial phase of infection.
METHODS: This was a multicenter retrospective observational study involving patients with culture-proven AB at six tertiary hospitals in Japan between January 2012 and March 2022. Data on clinical characteristics, laboratory and radiological findings were collected, and their associations with the absence of detectable abscess lesions were analyzed.
RESULTS: In total, 393 participants were included. Abscess lesions were absent in 42.7% of the entire cohort and detectable in the remaining patients. No differences were identified in the malignancy, severity, or 30-day mortality between patients with and without detectable abscess lesions. Multivariate logistic regression analysis adjusted for age and the modified Charlson comorbidity score revealed that the immunosuppressive status (febrile neutropenia or corticosteroid use), C-reactive protein (CRP) level ≤9.8 mg/dL at onset, and the presence of gram-positive anaerobic rods (GPARs) were independently associated with AB unaccompanied by detectable abscess lesions [odds ratios (ORs) 3.24, 3.00, and 2.81, respectively; p < 0.05].
CONCLUSIONS: This study elucidated distinctive clinical and microbiological characteristics of AB unaccompanied by detectable abscess lesions, with relatively lower CRP elevation, immunosuppressive status, and GPARs as the causative anaerobes.