Clinical characteristics of patients with severe sepsis and septic shock in relation to bacterial virulence of beta-hemolytic Streptococcus and Streptococcus pneumoniae

被引：4

作者：

Hifumi, Toru ^{[1
]}

Fujishima, Seitaro ^{[2
]}

Ubukata, Kimiko ^{[2
]}

Hagiwara, Akiyoshi ^{[3
]}

Abe, Toshikazu ^{[4
]}

Ogura, Hiroshi ^{[5
]}

Shiraishi, Atsushi ^{[6
]}

Kushimoto, Shigeki ^{[7
]}

Saitoh, Daizoh ^{[8
]}

Mayumi, Toshihiko ^{[9
]}

Ikeda, Hiroto ^{[10
]}

Ueyama, Masashi ^{[11
,12
]}

Otomo, Yasuhiro ^{[13
]}

Okamoto, Kohji ^{[14
]}

Umemura, Yutaka ^{[5
]}

Kotani, Joji ^{[15
]}

Sakamoto, Yuichiro ^{[16
]}

Sasaki, Junichi ^{[17
]}

Shiino, Yasukazu ^{[18
]}

Shiraishi, Shin-ichiro ^{[19
]}

Takuma, Kiyotsugu ^{[20
]}

Tarui, Takehiko ^{[21
]}

Tsuruta, Ryosuke ^{[22
]}

Nakada, Taka-aki ^{[23
]}

Yamakawa, Kazuma ^{[24
]}

Masuno, Tomohiko ^{[25
]}

Takeyama, Naoshi ^{[26
]}

Yamashita, Norio ^{[27
]}

Fujimi, Satoshi ^{[24
]}

Gando, Satoshi ^{[28
]}

机构：

[1] St Lukes Int Hosp, Dept Emergency & Crit Care Med, Emergency Med Ctr, Tokyo, Japan

[2] Keio Univ, Ctr Gen Med Educ, Sch Med, Tokyo, Japan

[3] Ctr Hosp, Natl Ctr Global Hlth & Med, Emergency Med, Tokyo, Japan

[4] Juntendo Univ, Dept Gen Med, Tokyo, Japan

[5] Osaka Univ, Dept Traumatol & Acute Crit Med, Grad Sch Med, Suita, Osaka, Japan

[6] Kameda Med Ctr, Emergency Dept, Kamogawa, Japan

[7] Tohoku Univ, Div Emergency & Crit Care Med, Grad Sch Med, Sendai, Miyagi, Japan

[8] Natl Def Med Coll, Res Inst, Div Traumatol, Saitama, Japan

[9] Univ Occupat & Environm Hlth, Sch Med, Dept Emergency Med, Kitakyushu, Fukuoka, Japan

[10] Teikyo Univ, Dept Emergency Med, Sch Med, Tokyo, Japan

[11] Japan Community Healthcare Org, Dept Trauma, Crit Care Med, Chukyo Hosp, Nagoya, Aichi, Japan

[12] Japan Community Healthcare Org, Burn Ctr, Chukyo Hosp, Nagoya, Aichi, Japan

[13] Tokyo Med & Dent Univ, Med Hosp, Trauma & Acute Crit Care Med Ctr, Tokyo, Japan

[14] Kitakyushu City Yahata Hosp, Ctr Gastroenterol & Liver Dis, Dept Surg, Kitakyushu, Fukuoka, Japan

[15] Hyogo Coll Med, Dept Emergency Disaster & Crit Care Med, Nishinomiya, Hyogo, Japan

[16] Saga Univ Hosp, Emergency & Crit Care Med, Saga, Japan

[17] Keio Univ, Dept Emergency & Crit Care Med, Sch Med, Tokyo, Japan

[18] Kawasaki Med Sch, Dept Acute Med, Kurashiki, Okayama, Japan

[19] Aizu Chuo Hosp, Dept Emergency & Crit Care Med, Fukushima, Japan

[20] Kawasaki Municipal Kawasaki Hosp, Emergency & Crit Care Ctr, Kawasaki, Kanagawa, Japan

[21] Kyorin Univ, Dept Trauma & Crit Care Med, Sch Med, Mitaka, Tokyo, Japan

[22] Yamaguchi Univ, Adv Med Emergency & Crit Care Ctr, Ube, Yamaguchi, Japan

[23] Chiba Univ, Dept Emergency & Crit Care Med, Grad Sch Med, Chiba, Japan

[24] Osaka Gen Med Ctr, Div Trauma & Surg Crit Care, Osaka, Japan

[25] Nippon Med Sch, Dept Emergency & Crit Care Med, Tokyo, Japan

[26] Aichi Med Univ Hosp, Adv Crit Care Ctr, Nagakute, Aichi, Japan

[27] Kurume Univ Hosp, Adv Emergency Med Serv Ctr, Kurume, Fukuoka, Japan

[28] Hokkaido Univ, Div Acute & Crit Care Med, Grad Sch Med, Sapporo, Hokkaido, Japan

来源：

ACUTE MEDICINE & SURGERY | 2020年 / 7卷 / 01期

关键词：

Beta-hemolytic Streptococcus; sepsis; Streptococcus pneumoniae; INTERNATIONAL SOCIETY; INVASIVE INFECTIONS; EQUISIMILIS; RESISTANCE; THROMBOSIS; PYOGENES; JAPAN; SCORE;

D O I：

10.1002/ams2.513

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aim: Combined detailed analysis of patient characteristics and treatment as well as bacterial virulence factors, which all play a central role in the cause of infections leading to severe illness, has not been reported. We aimed to describe the patient characteristics (Charlson comorbidity index [CCI]), treatment (3-h bundle), and outcomes in relation to bacterial virulence of Streptococcus pneumoniae and beta-hemolytic Streptococcus (BHS). Methods: This sepsis primary study is part of the larger Focused Outcomes Research in Emergency Care in Acute Respiratory Distress Syndrome, Sepsis and Trauma (FORECAST) study, a multicenter, prospective cohort study. We included patients diagnosed with S. pneumoniae and BHS sepsis and examined virulence, defining the high-virulence factor as follows: S. pneumoniae serotype 3, 31, 11A, 35F, and 17F; Streptococcus pyogenes, emm 1; Streptococcus agalactiae, III; and Streptococcus dysgalactiae ssp. equisimilis, emm typing pattern stG 6792. Included patients were divided into high and normal categories based on the virulence factor. Results: Of 1,184 sepsis patients enrolled in the Japanese Association for Acute Medicine's FORECAST study, 62 were included in the current study (29 cases with S. pneumoniae sepsis and 33 with BHS). The CCI and completion of a 3-h bundle did not differ between normal and high virulence groups. Risk of 28-day mortality was significantly higher for high-virulence compared to normal-virulence when adjusted for CCI and completion of a 3-h bundle (Cox proportional hazards regression analysis, hazard ratio 3.848; 95% confidence interval, 1.108-13.370; P = 0.034). Conclusion: The risk of 28-day mortality was significantly higher for patients with high-virulence compared to normal-virulence bacteria.

引用

页数：8

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