不同免疫受损宿主中的格拉姆阴性细菌病的流行病学特征和管理:观察性单中心研究
Alice Toschi1, Renato Pascale1,2, Dino Gibertoni3
1Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Bologna, Italy.
格拉姆阴性血流感染 (GN-BSI) 在不同的免疫受损 (IC) 患者群体中呈现独特的流行病学特征和结果,包括固体器官移植接受者和患有血液恶性瘤的人. 个性化管理策略对于优化这些不同人群中的患者结果至关重要.
科学领域:
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
- 流行病学 流行病学
背景情况:
- 格拉姆阴性血流感染 (GN-BSI) 是致病率和死亡率的重要原因.
- 免疫受损 (IC) 状态是影响GN-BSI结果的关键因素,但免疫抑制的范围是多样化的.
- 目前对IC患者的分类可能无法完全捕捉影响GN-BSI管理和预后的细微差别.
研究的目的:
- 在不同类别的免疫功能低下患者中调查GN-BSI的流行病学特征,管理策略和临床结果.
- 为了比较固体器官移植 (SOT) 接受者,血液恶性瘤 (HM) 患者,转移性固体癌症 (mSC) 患者和非主要IC (nm-IC) 患者之间的结果.
- 根据特定的患者个人资料,为GN-BSI提供个性化管理方法.
主要方法:
- 追溯单一中心研究分析了3544名在7年内患有GN-BSI的住院患者.
- 患者被分为四组:SOT接受者,HM患者,mSC患者和nm-IC患者.
- 收集的数据包括患者人口统计,查尔森并发症指数 (CCI),感染源,治疗持续时间和死亡率.
主要成果:
- 在IC组中观察到年龄,CCI和感染源的显著差异.
- 尿路感染在nm-IC中最常见,而腹内感染在SOT和mSC群中占主导地位.
- 死亡率在mSC患者中最高 (19.9%),在SOT接受者中最低 (8.2%).
- 在SOT接受者中复发率最高 (18.8%).
- 随访血液培养减少了nm-IC和mSC患者的死亡率.
- 至少7天的治疗与SOT和HM患者的90天死亡率较低有关.
结论:
- 在免疫功能低下患者的不同亚组中,GN-BSI的临床表现,管理和结果存在显著差异.
- 在IC患者中管理GN-BSI的一种适合所有人的方法是不充分的.
- 量身定制的治疗策略,考虑到患者的特定特征和免疫抑制条件,对于改善患者的治疗结果至关重要.
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