대한응급의학회지 (Journal of The Korean Society of Emergency Medicine)

  • 제29권5호
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  • Pages.474-484
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  • 2018
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  • 1226-4334(pISSN)
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  • 2384-048X(eISSN)
대한응급의학회 (The Korean Society of Emergency Medicine)
권호 표지

Relationship between the time to positivity of blood culture and mortality according to the site of infection in sepsis

  • ;
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  • 조유환 (분당서울대학교병원 응급의학과) ;
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  • Um, Young Woo (Department of Emergency Medicine, Seoul National University Bundang Hospital) ;
  • Lee, Jae Hyuk (Department of Emergency Medicine, Seoul National University Bundang Hospital) ;
  • Jo, You Hwan (Department of Emergency Medicine, Seoul National University Bundang Hospital) ;
  • Kim, Joonghee (Department of Emergency Medicine, Seoul National University Bundang Hospital) ;
  • Kim, Yu Jin (Department of Emergency Medicine, Seoul National University Bundang Hospital) ;
  • Kwon, Hyuksool (Department of Emergency Medicine, Seoul National University Bundang Hospital)
  • 투고 : 2018.07.19
  • 심사 : 2018.09.03
  • 발행 : 2018.10.31

⟨ 이전 논문 다음 논문 ⟩

초록

Objective: The time to positivity (TTP) of blood culture reflects bacterial load and has been reported to be associated with outcome in bloodstream infections. This study was performed to evaluate the relationship between the TTP of blood culture and the mortality rates associated with sepsis and septic shock according to the site of infection. Methods: We performed a retrospective cohort study on patients with sepsis and septic shock. The rates of blood culture positivity and mortality as well as the relationship between the TTP and 28-day mortality rate were compared among patients with different sites of infection, such as the lungs, abdomen, urogenital tract, and other sites. Results: A total of 2,668 patients were included, and the overall mortality rate was 21.6%. The rates of blood culture positivity and mortality were different among the different infection sites. There was no relationship between the TTP and mortality rates of total, lung, and urogenital infections. Patients with abdominal infections showed a negative correlation between the TTP and 28-day mortality rate. In patients with abdominal infections, a TTP<20 hours was independently associated with 28-day mortality compared with patients with negative blood culture (hazard ratio, 1.73; 95% confidence interval, 1.16-2.58). However, there was no difference in mortality rates of patients with a $TTP{\geq}20$ hours and a negative blood culture. Conclusion: The shorter TTP in patients with abdominal infections in sepsis and septic shock was associated with a higher 28-day mortality rate.

키워드

참고문헌

  1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801-10. https://doi.org/10.1001/jama.2016.0287
  2. Mayr FB, Yende S, Angus DC. Epidemiology of severe sepsis. Virulence 2014;5:4-11. https://doi.org/10.4161/viru.27372
  3. Kaukonen KM, Bailey M, Suzuki S, Pilcher D, Bellomo R. Mortality related to severe sepsis and septic shock among critically ill patients in Australia and New Zealand, 2000-2012. JAMA 2014;311:1308-16. https://doi.org/10.1001/jama.2014.2637
  4. Vincent JL, Pereira AJ, Gleeson J, Backer D. Early management of sepsis. Clin Exp Emerg Med 2014;1:3-7. https://doi.org/10.15441/ceem.14.005
  5. Rello J, Lisboa T, Lujan M, et al. Severity of pneumococcal pneumonia associated with genomic bacterial load. Chest 2009;136:832-40. https://doi.org/10.1378/chest.09-0258
  6. Lala HM, Mills GD, Barratt K, Bonning J, Manikkam NE, Martin D. Meningococcal disease deaths and the frequency of antibiotic administration delays. J Infect 2007;54:551-7. https://doi.org/10.1016/j.jinf.2006.10.050
  7. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med 2017;45:486-552. https://doi.org/10.1097/CCM.0000000000002255
  8. Ning Y, Hu R, Yao G, Bo S. Time to positivity of blood culture and its prognostic value in bloodstream infection. Eur J Clin Microbiol Infect Dis 2016;35:619-24. https://doi.org/10.1007/s10096-016-2580-5
  9. Martinez JA, Pozo L, Almela M, et al. Microbial and clinical determinants of time-to-positivity in patients with bacteraemia. Clin Microbiol Infect 2007;13:709-16. https://doi.org/10.1111/j.1469-0691.2007.01736.x
  10. Willmann M, Kuebart I, Vogel W, et al. Time to positivity as prognostic tool in patients with Pseudomonas aeruginosa bloodstream infection. J Infect 2013;67:416-23. https://doi.org/10.1016/j.jinf.2013.06.012
  11. Cilloniz C, Ceccato A, de la Calle C, et al. Time to blood culture positivity as a predictor of clinical outcomes and severity in adults with bacteremic pneumococcal pneumonia. PLoS One 2017;12:e0182436. https://doi.org/10.1371/journal.pone.0182436
  12. Leligdowicz A, Dodek PM, Norena M, et al. Association between source of infection and hospital mortality in patients who have septic shock. Am J Respir Crit Care Med 2014;189:1204-13. https://doi.org/10.1164/rccm.201310-1875OC
  13. Ranieri VM, Thompson BT, Barie PS, et al. Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med 2012;366:2055-64. https://doi.org/10.1056/NEJMoa1202290
  14. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003;31:1250-6. https://doi.org/10.1097/01.CCM.0000050454.01978.3B
  15. Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsisrelated Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10. https://doi.org/10.1007/BF01709751
  16. Dellinger RP, Levy MM, Carlet JM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Intensive Care Med 2008;34:17-60. https://doi.org/10.1007/s00134-007-0934-2
  17. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39:165-228. https://doi.org/10.1007/s00134-012-2769-8
  18. Jo YH, Kim K, Lee JH, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med 2013;31:545-8. https://doi.org/10.1016/j.ajem.2012.10.017
  19. Durrleman S, Simon R. Flexible regression models with cubic splines. Stat Med 1989;8:551-61. https://doi.org/10.1002/sim.4780080504
  20. McKinley S, Levine M. Cubic spline interpolation. Coll Redw 1998;45:1049-60.
  21. Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32-5. https://doi.org/10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3
  22. Navasa M, Rodes J. Bacterial infections in cirrhosis. Liver Int 2004;24:277-80. https://doi.org/10.1111/j.1478-3231.2004.0934.x
  23. Marra AR, Edmond MB, Forbes BA, Wenzel RP, Bearman GM. Time to blood culture positivity as a predictor of clinical outcome of Staphylococcus aureus bloodstream infection. J Clin Microbiol 2006;44:1342-6. https://doi.org/10.1128/JCM.44.4.1342-1346.2006
  24. Tang PC, Lee CC, Li CW, Li MC, Ko WC, Lee NY. Time-to-positivity of blood culture: An independent prognostic factor of monomicrobial Pseudomonas aeruginosa bacteremia. J Microbiol Immunol Infect 2017;50:486-93. https://doi.org/10.1016/j.jmii.2015.08.014
  25. Zahar JR, Timsit JF, Garrouste-Orgeas M, et al. Outcomes in severe sepsis and patients with septic shock: pathogen species and infection sites are not associated with mortality. Crit Care Med 2011;39:1886-95. https://doi.org/10.1097/CCM.0b013e31821b827c
  26. Brun-Buisson C, Doyon F, Carlet J, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults: a multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. JAMA 1995;274:968-74. https://doi.org/10.1001/jama.1995.03530120060042