死亡率预测因素和对复杂凝血酶阴性葡萄球菌细菌性病的定义建议:多中心前性队列研究
Benedetta Varisco1, Pedro María Martínez Pérez-Crespo2, Pilar Retamar-Gentil3
1Department of Health Sciences, Clinic of Infectious Diseases, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy.
概括
复杂的凝血酶负型葡萄球菌血流感染 (CoNS BSIs) 影响超过一半的患者,并与较高的死亡率有关. 早期导管切除和及时治疗对于改善CoNS BSI病例的结果至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 临床微生物学 临床微生物学
- 流行病学 流行病学
背景情况:
- 凝聚酶阴性葡萄球菌 (CoNS) 是血液感染 (BSI) 的重要原因,特别是在医疗机构.
- 定义复杂的CoNSBSI对于风险分层和指导治疗策略至关重要.
- 对于CoNS BSI患者的死亡率预测因素,需要进一步阐明以改善患者管理.
研究的目的:
- 为复杂的CoNS BSIs建立一个定义.
- 确定CoNS BSIs患者30天死亡率的独立预测因素.
- 评估特定标准对CoNS BSI死亡风险的影响.
主要方法:
- 在26个西班牙医院进行前性队列研究 (2016年10月 - 2017年3月).
- 包括445个CoNS BSI病例,详细收集有关感染特征和患者结果的数据.
- 考克斯回归分析以确定30天死亡率的独立预测因素.
主要成果:
- 复杂的CoNS BSI存在于53.9%的病例中,与显著更高的30天死亡率相关 (22.1%与11.7%相比).
- 死亡率的独立预测因素包括晚年,脑血管疾病,免疫抑制疗法,较高的SOFA得分和复杂的细菌病.
- 早期取出导管被发现具有保护性 (HR:0.47),而持续≥72小时的发烧增加了死亡风险 (HR:2.52).
结论:
- 很大一部分CoNSBSI符合复杂感染的标准,与死亡风险增加相关.
- 对于复杂的ConsBSI,提出的标准需要在更大的研究中进一步验证.
- 识别关键的死亡预测因素,如年龄,并发症和特定感染特征,可以指导临床决策.
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