Clinical characteristics and prognosis of pneumonia-related bloodstream infections in the intensive care unit: a single-center retrospective study

被引:0
作者
Liu, Yijie [1 ,2 ,3 ,4 ,5 ,6 ]
Sun, Ting [2 ,3 ,4 ,5 ,6 ]
Cai, Ying [2 ,3 ,4 ,5 ,6 ]
Zhai, Tianshu [2 ,3 ,4 ,5 ,6 ]
Huang, Linna [2 ,3 ,4 ,5 ,6 ]
Zhang, Qi [2 ,3 ,4 ,5 ,6 ]
Wang, Chunlei [2 ,3 ,4 ,5 ,6 ]
Chen, He [7 ]
Huang, Xu [2 ,3 ,4 ,5 ,6 ]
Li, Min [2 ,3 ,4 ,5 ,6 ]
Xia, Jingen [2 ,3 ,4 ,5 ,6 ]
Gu, Sichao [2 ,3 ,4 ,5 ,6 ]
Guo, Lingxi [2 ,3 ,4 ,5 ,6 ]
Yang, Bin [8 ]
Wu, Xiaojing [2 ,3 ,4 ,5 ,6 ,9 ]
Lu, Binghuai [2 ,3 ,4 ,5 ,6 ]
Zhan, Qingyuan [1 ,2 ,3 ,4 ,5 ,6 ]
机构
[1] Chinese Acad Med Sci, Peking Union Med Coll, Grad Sch, Beijing, Peoples R China
[2] China Japan Friendship Hosp, Natl Ctr Resp Med, Beijing, Peoples R China
[3] China Japan Friendship Hosp, State Key Lab Resp Hlth & Multimorbid, Beijing, Peoples R China
[4] China Japan Friendship Hosp, Natl Clin Res Ctr Resp Dis, Beijing, Peoples R China
[5] Chinese Acad Med Sci, China Japan Friendship Hosp, Inst Resp Med, Beijing, Peoples R China
[6] China Japan Friendship Hosp, Ctr Resp Med, Dept Pulm & Crit Care Med, Beijing, Peoples R China
[7] China Japan Friendship Hosp, Dept Radiol, Beijing, Peoples R China
[8] Vis Med Ctr Infect Dis, Guangzhou, Peoples R China
[9] Nanchang Univ, Affiliated Hosp 1, Dept Pulm & Crit Care Med, Nanchang, Jiangxi, Peoples R China
关键词
bloodstream infections; pneumonia-related bloodstream infections; clinical characteristics; intensive care unit; gram-negative bacteria; ATTRIBUTABLE MORTALITY; EPIDEMIOLOGY; SURVEILLANCE; HOSPITALS; SEPSIS; IMPACT; SCORE;
D O I
10.3389/fpubh.2023.1249695
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Bloodstream infections (BSI) are one of the most severe healthcare-associated infections in intensive care units (ICU). However, there are few studies on pneumonia-related BSI (PRBSI) in the ICU. This study aimed to investigate the clinical and prognostic characteristics of patients with PRBSI in the ICU and to provide a clinical basis for early clinical identification.Methods: We retrospectively collected data from patients with bacterial BSI in a single-center ICU between January 1, 2017, and August 31, 2020. Clinical diagnosis combined with whole-genome sequencing (WGS) was used to clarify the diagnosis of PRBSI, and patients with PRBSI and non-PRBSI were analyzed for clinical features, prognosis, imaging presentation, and distribution of pathogenic microorganisms.Results: Of the 2,240 patients admitted to the MICU, 120 with bacterial BSI were included in this study. Thirty-two (26.7%) patients were identified as having PRBSI based on the clinical diagnosis combined with WGS. Compared to patients without PRBSI, those with PRBSI had higher 28-day mortality (81.3 vs.51.1%, p = 0.003), a higher total mortality rate (93.8 vs. 64.8%, p = 0.002), longer duration of invasive mechanical ventilation (median 16 vs. 6 days, p = 0.037), and prolonged duration of ICU stay (median 21 vs. 10 days, p = 0.004). There were no differences in other baseline data between the two groups, but patients with PRBSI had extensive consolidation on chest radiographs and significantly higher Radiographic Assessment of Lung Edema scores (mean 35 vs. 24, p < 0.001). The most common causative organisms isolated in the PRBSI group were gram-negative bacteria (n = 31, 96.9%), with carbapenem-resistant gram-negative bacteria accounting for 68.8% (n = 22) and multidrug-resistant bacteria accounting for 81.3% (n = 26).Conclusion: Pneumonia-related BSI is an important component of ICU-BSI and has a poor prognosis. Compared to non-PRBSI, patients with PRBSI do not have typical clinical features but have more severe lung consolidation lesions, and should be alerted to the possibility of their occurrence when combined with pulmonary gram-negative bacterial infections, especially carbapenem-resistant bacteria. Further multicenter, large-sample studies are needed to identify the risk factors for the development of PRBSI and prevention and treatment strategies.
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页数:11
相关论文
共 36 条
[1]   Attributable mortality of ICU-acquired bloodstream infections: Impact of the source, causative micro-organism, resistance profile and antimicrobial therapy [J].
Adrie, Christophe ;
Garrouste-Orgeas, Maite ;
Ibn Essaied, Wafa ;
Schwebel, Carole ;
Darmon, Michael ;
Mourvillier, Bruno ;
Ruckly, Stephane ;
Dumenil, Anne-Sylvie ;
Kallel, Hatem ;
Argaud, Laurent ;
Marcotte, Guillaume ;
Barbier, Francois ;
Laurent, Virginie ;
Goldgran-Toledano, Dany ;
Clec'h, Christophe ;
Azoulay, Elie ;
Souweine, Bertrand ;
Timsit, Jean-Francois .
JOURNAL OF INFECTION, 2017, 74 (02) :131-141
[2]   Chest Radiograph Scoring Alone or Combined with Other Risk Scores for Predicting Outcomes in COVID-19 (Jan, 10.1148/radiol.219029, 2022) [J].
Chandra, Vishnu .
RADIOLOGY, 2022, 302 (02) :460-469
[3]   Identification of Escherichia coli and Shigella Species from Whole-Genome Sequences [J].
Chattaway, Marie A. ;
Schaefer, Ulf ;
Tewolde, Rediat ;
Dallman, Timothy J. ;
Jenkins, Claire .
JOURNAL OF CLINICAL MICROBIOLOGY, 2017, 55 (02) :616-623
[4]   Antimicrobial resistance and antibiotic stewardship programs in the ICU: insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance [J].
De Waele, Jan J. ;
Akova, Murat ;
Antonelli, Massimo ;
Canton, Rafael ;
Carlet, Jean ;
De Backer, Daniel ;
Dimopoulos, George ;
Garnacho-Montero, Jose ;
Kesecioglu, Jozef ;
Lipman, Jeffrey ;
Mer, Mervyn ;
Paiva, Jose-Artur ;
Poljak, Mario ;
Roberts, Jason A. ;
Rodriguez-Bano, Jesus ;
Timsit, Jean-Francois ;
Zahar, Jean-Ralph ;
Bassetti, Matteo .
INTENSIVE CARE MEDICINE, 2018, 44 (02) :189-196
[5]   Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals [J].
Delle Rose, Diego ;
Sordillo, Pasquale ;
Gini, Sabina ;
Cerva, Carlotta ;
Boros, Stefano ;
Rezza, Giovanni ;
Meledandri, Marcello ;
Gallo, Maria Teresa ;
Prignano, Grazia ;
Caccese, Roberta ;
D'Ambrosio, Mario ;
Citterio, Giorgia ;
Rocco, Monica ;
Leonardis, Francesca ;
Natoli, Silvia ;
Fontana, Carla ;
Favaro, Marco ;
Celeste, Maria Grazia ;
Franci, Tiziana ;
Testore, Gian Piero ;
Andreoni, Massimo ;
Sarmati, Loredana .
AMERICAN JOURNAL OF INFECTION CONTROL, 2015, 43 (11) :1178-1183
[6]   CDC DEFINITIONS FOR NOSOCOMIAL INFECTIONS, 1988 [J].
GARNER, JS ;
JARVIS, WR ;
EMORI, TG ;
HORAN, TC ;
HUGHES, JM .
AMERICAN JOURNAL OF INFECTION CONTROL, 1988, 16 (03) :128-140
[7]   Epidemiology of ICU-Onset Bloodstream Infection: Prevalence, Pathogens, and Risk Factors Among 150,948 ICU Patients at 85 US Hospitals [J].
Gouel-Cheron, Aurelie ;
Swihart, Bruce J. ;
Warner, Sarah ;
Mathew, Lauren ;
Strich, Jeffrey R. ;
Mancera, Alex ;
Follmann, Dean ;
Kadri, Sameer S. .
CRITICAL CARE MEDICINE, 2022, 50 (12) :1725-1736
[8]   Increased antibiotic use in Norwegian hospitals despite a low antibiotic resistance rate [J].
Haug, Jon Birger ;
Berild, Dag ;
Walberg, Mette ;
Reikvam, Asmund .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2011, 66 (11) :2643-2646
[9]   Pathogenesis of Gram-Negative Bacteremia [J].
Holmes, Caitlyn L. ;
Anderson, Mark T. ;
Mobley, Harry L. T. ;
Bachman, Michael A. .
CLINICAL MICROBIOLOGY REVIEWS, 2021, 34 (02)
[10]   CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting [J].
Horan, Teresa C. ;
Andrus, Mary ;
Dudeck, Margaret A. .
AMERICAN JOURNAL OF INFECTION CONTROL, 2008, 36 (05) :309-332