Title Učestalost i kliničke značajke dokazanih bakterijemija iz opće populacije Title (english) Incidence and clinical characteristics of community-acquired bacteremia Author Martina Čuljak Mentor Marija Santini (mentor)Committee member Dalibor Vukelić (predsjednik povjerenstva)Committee member Goran Tešović (član povjerenstva)Committee member Marija Santini (član povjerenstva)Granter University of Zagreb Defense date and country 2022-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Bakterijemije iz opće populacije (eng. community-acquired, CA) uglavnom su uzrokovane relativno virulentnim patogenima koji inficiraju inače zdravo stanovništvo koje prethodno nije bilo u kontaktu sa zdravstvenom skrbi. Kriterij za CA-bakterijemiju su pozitivne hemokulture dobivene pri prijemu ili unutar 48 sati od prijema u bolnicu. Cilj istraživanja bio je opisati demografske, kliničke i mikrobiološke značajke bolesnika s bakterijemijom te trendove u pojavnosti bakterijemija za 10-godišnje razdoblje istraživanja. U ovu retrospektivnu opservacijsku studiju uključeni su svi odrasli bolesnici s pozitivnim hemokulturama koji su ispunili kriterije za CA-bakterijemiju te potom hospitalizirani u Klinici za infektivne bolesti „Dr. Fran Mihaljević“ tijekom razdoblja 2007.-2016. godine. Od 1956 bolesnika uključenih u istraživanje, 56% bile su žene (1105), a medijan dobi bio je 68 godina (IQR 56-78). CCI (eng. Charlson comorbidity score) medijan bio je 3 (IQR 2-5). Glavni uzročnici CA-bakterijemije bile su bakterije iz koljena Escherichiae (1012/1984, 51%), Streptococcus (382/1984, 19%) i Staphylococcus (207/1984, 10%). Bakterijemije su pretežito sekundarne s ishodištima infekcije u urinarnom traktu u 51%, koži 10%, respiratornom 9% i gastrointestinalnom traktu u 9% slučajeva. U 4% izvor je bio endokarditis, CNS u 2% te infekcije kosti također u 2% bakterijemija. Primarna bakterijemija javila se u 13% slučajeva. Ukupni mortalitet je 4,9% (96/1956). Za muškarce je iznosio 5,8%, a za žene 4,3%. Medijan hospitalizacije u Klinici bio je 14 (IQR 10-18) dana. Za 240 bolesnika liječenih na Zavodu za intenzivnu medicinu bio je 8 (IQR 4-14,5) dana. Mortalitet liječenih u jedinici intenzvnog liječenja bio je 23% (55/96). Bakterijemije iz opće populacije predstavljaju značajan klinički problem koji ulavnom pogađa osobe starije životne dobi opterećene višestrukim komorbiditetima (najčešće šećernom bolesti). Najčešća ishodišta su infekcije urotrakta, kože, respiratornog i gastointestinalnog trakta. Ovaj klinički entitet povezan je i sa značajnom smrtnosti, osobito u bolesnika u JIL-u. Rezultati ukazuju na potrebu za kvalitetnom kontrolom kroničnih bolesti (osobito u osoba starije životne dobi) te na potrebu za prevencijom te ranim i adekvatnim liječenjem infekcija koje su najčešće ishodište bolesti.
Abstract (english) Community-acquired bacteremia (CA) is mainly caused by relatively virulent pathogens that affect an otherwise healthy population that has not previously been in contact with healthcare. Criteria for CA-bacteremia are positive blood cultures obtained on admission or within 48 hours of hospital admission. The aim of the study was to describe the demographic, clinical and microbiological characteristics of patients with bacteremia and trends in the incidence of bacteremia for the 10-year study period. This retrospective observational study included all adult patients with positive blood cultures who met the criteria for CA-bacteremia and were then hospitalized at the "Dr. Fran Mihaljević” infectious disease Clinic during the period from 2007 to 2016. Out of the 1956 patients enrolled in the study, 56% of the were female (1105), and the median age was 68 years (IQR 56-78). The CCI (Charlson comorbidity score) median was 3 (IQR 2-5). The main causative organisms of CA-bacteremia were bacteria from the genus Escherichiae (1012/1984, 51%), Streptococcus (382/1984, 19%) and Staphylococcus (207/1984, 10%). Bacteremias are predominantly secondary with infection sources found in the urinary tract (51%), skin (10%,) respiratory (9%), and gastrointestinal tract (9%). In the remaining cases the source was endocarditis (4%), CNS (2%) and bone (2%) infections. Primary bacteremia occurred in 13% of all cases. Total mortality is 4.9% (96/1956). It was 5.8% for men and 4.3% for women. The median length of stay at the Clinic was 14 (IQR 10-18) days. For 240 patients treated at the Department of Intensive Care, it was 8 (IQR 4-14,5) days. The mortality rate of those treated in ICU was 23% (55/96). Bacteremias from the general population represent a significant clinical problem that mainly affects the elderly burdened with multiple comorbidities (most commonly diabetes). The most common sources are infections of the urinary tract, skin, respiratory and gastrointestinal tract. This clinical entity is also associated with significant mortality, especially in ICU patients. The results point out the need for quality control of chronic diseases (especially in the elderly) and the need for prevention and early and adequate treatment of infections that are the most common source of the disease.
Keywords
bakterijemije
opća populacija
Escherichiae
mortalitet
Keywords (english)
Bacteremia
Community-acquired
Escherichiae
Mortality
Language croatian URN:NBN urn:nbn:hr:105:002089 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-01-05 08:37:22
