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Microbiological Analysis and Mortality Risk Factors in Patients with Polymicrobial Bloodstream Infections
PURPOSE: To study the etiological characteristics and risk factors affecting the prognosis of patients with polymicrobial bloodstream infections. PATIENTS AND METHODS: Overall, 141 patients with polymicrobial bloodstream infections in Henan Provincial People’s Hospital during 2021 were included. Lab...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Dove
2023
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290474/ https://www.ncbi.nlm.nih.gov/pubmed/37361937 http://dx.doi.org/10.2147/IDR.S412669 |
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author | Xu, Junhong Yuan, Youhua Wang, Baoya Zhang, Qi Wang, Jing Wang, Shanmei Li, Yi Yan, Wenjuan |
author_facet | Xu, Junhong Yuan, Youhua Wang, Baoya Zhang, Qi Wang, Jing Wang, Shanmei Li, Yi Yan, Wenjuan |
author_sort | Xu, Junhong |
collection | PubMed |
description | PURPOSE: To study the etiological characteristics and risk factors affecting the prognosis of patients with polymicrobial bloodstream infections. PATIENTS AND METHODS: Overall, 141 patients with polymicrobial bloodstream infections in Henan Provincial People’s Hospital during 2021 were included. Laboratory test indexes, department of admission, sex, age, intensive care unit (ICU) admission, surgical history, and central venous catheter placement were collected. Patients were divided into surviving and deceased groups based on outcomes at discharge. Mortality risk factors were identified by univariate and multivariable analyses. RESULTS: Seventy-two of 141 patients survived. Patients were mainly from the ICU and the Departments of Hepatobiliary Surgery and Hematology. Overall, 312 microbial strains were detected: 119 gram-positive, 152 gram-negative, and 13 anaerobic bacteria and 28 fungi. Among the gram-positive bacteria, coagulase-negative staphylococci were most frequent (44/119, 37%), followed by enterococci (35/119, 29.4%). Among coagulase-negative staphylococci, methicillin-resistant coagulase-negative staphylococci incidence was 75% (33/44). Among gram-negative bacteria, Klebsiella pneumoniae was most common (45/152, 29.6%), followed by Escherichia coli (25/152, 16.4%) and Pseudomonas aeruginosa (13/152, 8.6%). Among K. pneumoniae, the incidence of carbapenem-resistant (CR) K. pneumoniae was 45.7% (21/45). On univariate analysis, mortality risk factors included increased white blood cells and C-reactive protein, decreased total protein and albumin, CR strains, ICU admission, central venous catheter, multiple organ failure, sepsis, shock, pulmonary diseases, respiratory failure, central nervous system diseases, cardiovascular diseases, hypoproteinemia, and electrolyte disturbances (P < 0.05). Multivariable analysis showed that ICU admission, shock, electrolyte disorders, and central nervous system diseases were independent mortality risk factors. The survival curve shows that the survival rate of patients with polymicrobial CR bloodstream infections was lower than that of patients with polymicrobial non-CR bloodstream infections (P=0.029). CONCLUSION: Patients with polymicrobial bloodstream infections are typically critically ill and harbor multidrug-resistant bacteria. Thus, to minimize mortality rate in critically ill patients, changes in infectious flora should be monitored, antibiotics selected reasonably, and invasive procedures reduced. |
format | Online Article Text |
id | pubmed-10290474 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Dove |
record_format | MEDLINE/PubMed |
spelling | pubmed-102904742023-06-25 Microbiological Analysis and Mortality Risk Factors in Patients with Polymicrobial Bloodstream Infections Xu, Junhong Yuan, Youhua Wang, Baoya Zhang, Qi Wang, Jing Wang, Shanmei Li, Yi Yan, Wenjuan Infect Drug Resist Original Research PURPOSE: To study the etiological characteristics and risk factors affecting the prognosis of patients with polymicrobial bloodstream infections. PATIENTS AND METHODS: Overall, 141 patients with polymicrobial bloodstream infections in Henan Provincial People’s Hospital during 2021 were included. Laboratory test indexes, department of admission, sex, age, intensive care unit (ICU) admission, surgical history, and central venous catheter placement were collected. Patients were divided into surviving and deceased groups based on outcomes at discharge. Mortality risk factors were identified by univariate and multivariable analyses. RESULTS: Seventy-two of 141 patients survived. Patients were mainly from the ICU and the Departments of Hepatobiliary Surgery and Hematology. Overall, 312 microbial strains were detected: 119 gram-positive, 152 gram-negative, and 13 anaerobic bacteria and 28 fungi. Among the gram-positive bacteria, coagulase-negative staphylococci were most frequent (44/119, 37%), followed by enterococci (35/119, 29.4%). Among coagulase-negative staphylococci, methicillin-resistant coagulase-negative staphylococci incidence was 75% (33/44). Among gram-negative bacteria, Klebsiella pneumoniae was most common (45/152, 29.6%), followed by Escherichia coli (25/152, 16.4%) and Pseudomonas aeruginosa (13/152, 8.6%). Among K. pneumoniae, the incidence of carbapenem-resistant (CR) K. pneumoniae was 45.7% (21/45). On univariate analysis, mortality risk factors included increased white blood cells and C-reactive protein, decreased total protein and albumin, CR strains, ICU admission, central venous catheter, multiple organ failure, sepsis, shock, pulmonary diseases, respiratory failure, central nervous system diseases, cardiovascular diseases, hypoproteinemia, and electrolyte disturbances (P < 0.05). Multivariable analysis showed that ICU admission, shock, electrolyte disorders, and central nervous system diseases were independent mortality risk factors. The survival curve shows that the survival rate of patients with polymicrobial CR bloodstream infections was lower than that of patients with polymicrobial non-CR bloodstream infections (P=0.029). CONCLUSION: Patients with polymicrobial bloodstream infections are typically critically ill and harbor multidrug-resistant bacteria. Thus, to minimize mortality rate in critically ill patients, changes in infectious flora should be monitored, antibiotics selected reasonably, and invasive procedures reduced. Dove 2023-06-20 /pmc/articles/PMC10290474/ /pubmed/37361937 http://dx.doi.org/10.2147/IDR.S412669 Text en © 2023 Xu et al. https://creativecommons.org/licenses/by-nc/3.0/This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/ (https://creativecommons.org/licenses/by-nc/3.0/) ). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). |
spellingShingle | Original Research Xu, Junhong Yuan, Youhua Wang, Baoya Zhang, Qi Wang, Jing Wang, Shanmei Li, Yi Yan, Wenjuan Microbiological Analysis and Mortality Risk Factors in Patients with Polymicrobial Bloodstream Infections |
title | Microbiological Analysis and Mortality Risk Factors in Patients with Polymicrobial Bloodstream Infections |
title_full | Microbiological Analysis and Mortality Risk Factors in Patients with Polymicrobial Bloodstream Infections |
title_fullStr | Microbiological Analysis and Mortality Risk Factors in Patients with Polymicrobial Bloodstream Infections |
title_full_unstemmed | Microbiological Analysis and Mortality Risk Factors in Patients with Polymicrobial Bloodstream Infections |
title_short | Microbiological Analysis and Mortality Risk Factors in Patients with Polymicrobial Bloodstream Infections |
title_sort | microbiological analysis and mortality risk factors in patients with polymicrobial bloodstream infections |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290474/ https://www.ncbi.nlm.nih.gov/pubmed/37361937 http://dx.doi.org/10.2147/IDR.S412669 |
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