目的:将血培养阳性时间(TTP)作为死亡危险因素的研究显示出相互矛盾的结果。该研究的目的是在基于人群的血流感染(BSI)患者队列中检查TTP对所有30天病死率的影响。
方法:一项回顾性队列研究,包括昆士兰州所有居民,澳大利亚在2000-2019年期间在公共资助的医疗保健系统中管理了单抗微生物BSI事件。临床,TTP,所有原因30天病死率信息都是从全州来源获得的。
结果:收集了88,314名患者的队列。中位TTP为14小时,第五,25日,75,和第4、10、20和53小时的第95百分位数,分别。TTP因BSI病因而显着变化。30天全因病死率为2,606/17,879(14.6%),2,834/24,272(11.7%),2,378/20,359(11.7%),和2,752/22,431(12.3%)在第一个,第二,第三,和第四个TTP四分位数,分别(p<0.0001)。调整后的年龄,性别,发病,合并症,和感染的焦点,10小时内TTP(第一四分位数)与死亡风险显著增加相关(比值比1.43;95%置信区间1.35-1.50;p<0.001)。在对混杂变量(赔率比;95%置信区间)进行调整后,金黄色葡萄球菌的第一个四分位数内的TTP(1.56;1.41-1.73),肺炎链球菌(1.91;1.49-2.46),β-溶血性链球菌(1.23;1.00-1.50),假单胞菌属(2.23;1.85-2.69),大肠杆菌(1.37;1.23-1.53),肠杆菌(1.38;1.16-1.63),其他革兰氏阴性(1.68;1.36-2.06),和厌氧菌(1.58;1.28-1.94)增加了病死率的风险。
结论:这项基于人群的分析提供了证据,证明TTP是BSI患者死亡率的重要决定因素。
OBJECTIVE: Studies examining time to positivity (TTP) of blood cultures as a risk factor for death have shown conflicting results. The study objective was to examine the effect of TTP on all-cause-30-day case-fatality among a population-based cohort of patients with bloodstream infections (BSI).
METHODS: A retrospective cohort study including all residents of Queensland, Australia with incident monomicrobial BSI managed in the publicly funded healthcare system from 2000 to 2019 was performed. Clinical, TTP and all-cause 30-day case-fatality information was obtained from state-wide sources.
RESULTS: A cohort of 88 314 patients was assembled. The median TTP was 14 hours, with 5th, 25th, 75th, and 95th percentiles of 4, 10, 20, and 53 hours, respectively. The TTP varied significantly by BSI aetiology. The 30-day all-cause case-fatality rate was 2606/17 879 (14.6%), 2834/24 272 (11.7%), 2378/20 359 (11.7%), and 2752/22 431 (12.3%) within the first, second, third, and fourth TTP quartiles, respectively (p < 0.0001). After adjustment for age, sex, onset, comorbidity, and focus of infection, TTP within 10 hours (first quartile) was associated with a significantly increased risk for death (odds ratio 1.43; 95% CI, 1.35-1.50; p < 0.001). After adjustment for confounding variables (odds ratio; 95% CI), TTP within the first quartile for Staphylococcus aureus (1.56; 1.41-1.73), Streptococcus pneumoniae (1.91; 1.49-2.46), β-hemolytic streptococci (1.23; 1.00-1.50), Pseudomonas species (2.23; 1.85-2.69), Escherichia coli (1.37; 1.23-1.53), Enterobacterales (1.38; 1.16-1.63), other Gram-negatives (1.68; 1.36-2.06), and anaerobes (1.58; 1.28-1.94) increased the risk for case-fatality.
CONCLUSIONS: This population-based analysis provides evidence that TTP is an important determinant of mortality among patients with BSI.