目的:阐明多微生物菌血症(PMB)的临床和微生物特征,为临床诊断和早期有效治疗提供帮助。
方法:这项回顾性多中心研究使用了冈山县三家急诊医院的数据,Japan,在2014年1月至2019年3月之间收集。我们回顾了人口统计,合并症,分离的生物体,感染焦点,以及PMB患者的30天死亡率。
结果:在7233个阳性血培养物中,808(11.2%)对一种以上的生物体呈阳性。在菌血症患者中,507(7.0%)有PMB,其中65.3%为男性。在78.3%的病例中发现了感染灶,其中腹腔内感染占47.1%。革兰氏阳性球菌(GPC)(链状)和革兰氏阴性杆菌(GNR)的组合占病例的32.9%,GPC/GNR和GNR/GNR模式与腹腔感染显著相关。PMB患者30天死亡率为18.1%,从诊断到死亡的中位数为7.5天。确定有感染灶的患者的死亡率显着低于无感染灶的患者(16.3%vs.24.5%;p=0.031)。
结论:腹腔内感染是PMB的最常见来源,并且与GPC(链形式)/GNR的革兰氏染色组合模式密切相关。病灶不明的PMB病例预后较差,强调早期诊断和适当治疗的重要性。
OBJECTIVE: To clarify the clinical and microbial characteristics of polymicrobial bacteremia (PMB) to contribute to improvements in clinical diagnosis and effective early treatment.
METHODS: This retrospective multicenter study used data from three acute-care hospitals in Okayama Prefecture, Japan, collected between January 2014 and March 2019. We reviewed the demographics, comorbidities, organisms isolated, infectious focus, and 30-day mortality of patients with PMB.
RESULTS: Of the 7233 positive blood cultures, 808 (11.2%) were positive for more than one organism. Of the patients with bacteremia, 507 (7.0%) had PMB, of whom 65.3% were male. Infectious foci were identified in 78.3% of the cases, of which intra-abdominal infections accounted for 47.1%. A combination of Gram-positive cocci (GPC) (chain form) and Gram-negative rods (GNR) accounted for 32.9% of the cases, and GPC/GNR and GNR/GNR patterns were significantly associated with intra-abdominal infections. The 30-day mortality rate of patients with PMB was 18.1%, with a median of 7.5 days from diagnosis to death. The mortality in patients with an infectious focus identified was significantly lower than that in patients with an unknown focus (16.3% vs. 24.5%; p = 0.031).
CONCLUSIONS: Intra-abdominal infections were the most common source of PMB, and were strongly associated with a Gram-staining combination pattern of GPC (chain form)/GNR. PMB cases with an unknown focus had a poorer prognosis, highlighting the importance of early diagnosis and appropriate treatment.