- 期刊
Predictors of Hospital Mortality in Adult Patients with Community-Acquired Bloodstream Infection in the Emergency Room
急診室菌血症患者住院中死亡之預測因子
摘要
Background: Bloodstream infections (BSI) continue to be a serious problem in the community, but data on the clinical predictors of hospital mortality associated with BSI patients presenting in the emergency department are limited in Taiwan. Objectives: To characterize the clinical and microbiological factors for hospital mortality from community-acquired BSI in emergency room (ER) patients. Methods: This 12-month prospective study was conducted at the Erlin branch of Changhua Christian Hospital from January 1, 2005 to December 31, 2005. All admitted patients over 18 years old with microbiologically confirmed BSI in the ER were enrolled. Data were collected on demographics, comorbid medical conditions, clinical profile, microorganisms, source of infection, antimicrobial susceptibility testing, empiric antibiotic therapy, and hospital outcome. The prognostic factors were studied using univariate logistic regression. Results: During the study period, a total of 90 cases of BSI were reported. The mean age of the patients was 70.1 years (range, 39 to 97 years), and 51 (56.6%) patients were women. The most common comorbidities were diabetes mellitus (42.2%), neurological disorder with poor performance (24.4%), cardiovascular disease (21.1%), liver cirrhosis (15.5%), and underlying malignancy (12.2%). The most common pathogens were Escherichia coli (49%), Klebsiella species (8.8%), and Staphylococcus aureus (7.8%). The most common sources of BSI were the urinary tract (47.8%), and intra-abdominal sites (22.2%). Abnormal body temperature was the most frequent clinical finding (85.5%), and 32% of the patients developed acute organ dysfunction in the ER. Appropriate empiric antibiotic therapy was administrated in 82.2% of the cases. The hospital mortality rate was 15.5%. Univariate analysis revealed the predictors of mortality were comorbid liver cirrhosis (OR 6.37, p=0.005), presence of severe sepsis or septic shock (OR 44.68, p＜0.001), and pneumonia (OR 42, p=0.004) or an intra-abdominal site (OR 34.36, p=0.001) as the source of infection. Conclusions: The predictors identified in this study provide important prognostic information for patients with community-acquired BSI on arrival in the ER.
並列摘要
Background: Bloodstream infections (BSI) continue to be a serious problem in the community, but data on the clinical predictors of hospital mortality associated with BSI patients presenting in the emergency department are limited in Taiwan. Objectives: To characterize the clinical and microbiological factors for hospital mortality from community-acquired BSI in emergency room (ER) patients. Methods: This 12-month prospective study was conducted at the Erlin branch of Changhua Christian Hospital from January 1, 2005 to December 31, 2005. All admitted patients over 18 years old with microbiologically confirmed BSI in the ER were enrolled. Data were collected on demographics, comorbid medical conditions, clinical profile, microorganisms, source of infection, antimicrobial susceptibility testing, empiric antibiotic therapy, and hospital outcome. The prognostic factors were studied using univariate logistic regression. Results: During the study period, a total of 90 cases of BSI were reported. The mean age of the patients was 70.1 years (range, 39 to 97 years), and 51 (56.6%) patients were women. The most common comorbidities were diabetes mellitus (42.2%), neurological disorder with poor performance (24.4%), cardiovascular disease (21.1%), liver cirrhosis (15.5%), and underlying malignancy (12.2%). The most common pathogens were Escherichia coli (49%), Klebsiella species (8.8%), and Staphylococcus aureus (7.8%). The most common sources of BSI were the urinary tract (47.8%), and intra-abdominal sites (22.2%). Abnormal body temperature was the most frequent clinical finding (85.5%), and 32% of the patients developed acute organ dysfunction in the ER. Appropriate empiric antibiotic therapy was administrated in 82.2% of the cases. The hospital mortality rate was 15.5%. Univariate analysis revealed the predictors of mortality were comorbid liver cirrhosis (OR 6.37, p=0.005), presence of severe sepsis or septic shock (OR 44.68, p＜0.001), and pneumonia (OR 42, p=0.004) or an intra-abdominal site (OR 34.36, p=0.001) as the source of infection. Conclusions: The predictors identified in this study provide important prognostic information for patients with community-acquired BSI on arrival in the ER.
延伸閱讀
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