Clinical and microbiological characteristics of polymicrobial bacteremia: a retrospective, multicenter study.

Autor:	Fukushima, Shinnosuke, Hagiya, Hideharu, Fujita, Koji, Kamiyama, Shinya, Yamada, Haruto, Kishida, Masayuki, Otsuka, Fumio
Předmět:	MORTALITY prevention BACTEREMIA RESEARCH ACADEMIC medical centers LOG-rank test RETROSPECTIVE studies ACQUISITION of data MANN Whitney U Test FISHER exact test CROSS infection METHICILLIN-resistant staphylococcus aureus INTRA-abdominal infections GRAM-positive bacterial infections MIXED infections SYMPTOMS CRITICAL care medicine DESCRIPTIVE statistics MEDICAL records PUBLIC hospitals CHI-squared test KAPLAN-Meier estimator SURVIVAL analysis (Biometry) COMMUNITY-acquired infections STAPHYLOCOCCUS aureus GRAM-negative bacterial diseases DATA analysis software MICROBIAL sensitivity tests EARLY diagnosis EARLY medical intervention DISEASE risk factors
Zdroj:	Infection; Oct2022, Vol. 50 Issue 5, p1233-1242, 10p, 1 Diagram, 5 Charts, 1 Graph
Abstrakt:	Purpose: 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. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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