Bloodstream Infection in Patients With Intestinal Fistula: A Retrospective Study

To delineate the clinical characteristics of intestinal fistula patients with Bloodstream infection (BSI).

Retrospective case series in Surgical Intensive Care Unit (SICU), Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China. Among a cohort of 204 patients with a diagnosis of intestinal fistula, 46 who were complicated with BSI were analysed retrospectively. Data was collected from January 1, 2018 to February 1, 2020.

Among the 204 patients with intestinal fistula, 46 patients showed positive blood cultures, which clearly had BSIs. Parenteral nutrition (PN) time (OR 1.08, 95% CI 1.04∼1.12, P < 0.01), transferred from external ICU (OR 3.68, 95% CI 1.48∼9.17, P = 0.01), septic shock (OR 4.61, 95% CI 1.77∼11.97, P < 0.01), APACHE II (OR 1.11, 95% CI 1.01∼1.22, P = 0.04) were significantly associated with BSI in patients with intestinal fistula. When APACHE II score exceeds 12.0 points or PN time exceeds 18.0 D, the chance of BSI in patients with intestinal fistula increases significantly. In addition, compared with the non-BSI group, BSI group had a higher mortality and expenses in ICU, longer stay in ICU and total hospital stay, and worse quality of life (all P < 0.05). A total of 105 isolates from samples (including sputum, pus and blood) of 46 patients in the BSI group, among which were mainly gram negative rods and fungi, as well as blood isolates. Importantly, in patients with intestinal fistula, BSIs caused by fungi accounted for 23.4%.

Long-term PN, transfer from external ICU, septic shock, and higher APACHE II scores are often associated with an increased probability of BSIs in patients with intestinal fistula and a higher mortality. Gram-negative bacteria are the main pathogenic bacteria in intestinal fistula patients with BSI, and patients with intestinal fistula are more likely to develop fungal BSIs.