Crit Care Med:脓毒症患者再次入院是新发感染还是复发感染呢?

2017-07-26 MedSci MedSci原创

再入院治疗常常伴随着脓毒症的发生,者通常被认为是复发性脓毒症。然而,目前尚不清楚复发以及新感染的脓毒症导致的再入院频率是多少。近期,一项发表在杂志Crit Care Med上的研究旨在评估90天复发性脓毒症的再入院情况是否由于与初发相同的部位和相同的病原体感染所致。此项研究为回顾性队列研究。入组人群来自密歇根大学健康系统。所有住院患者(2015年5月15日至2015年5月14日)由主要国际疾病分类

再入院治疗常常伴随着脓毒症的发生,者通常被认为是复发性脓毒症。然而,目前尚不清楚复发以及新感染的脓毒症导致的再入院频率是多少。


近期,一项发表在杂志Crit Care Med上的研究旨在评估90天复发性脓毒症的再入院情况是否由于与初发相同的部位和相同的病原体感染所致。

此项研究为回顾性队列研究。入组人群来自密歇根大学健康系统。所有住院患者(2015年5月15日至2015年5月14日)由主要国际疾病分类(第九版)的败血症(038.x),严重脓毒症(995.92)或败血性休克(785.52)的临床改良诊断,同时收集随后90天内的住院和脓毒症再入院情况。研究者们通过手动图表来确定脓毒症的生物体和部位。

此项研究最终在再入院的90天内鉴定了472例脓毒症,其中137例(29.1%)为败血症。脓毒症复发期间,泌尿生殖系统(29.2%)、胃肠道(20.4%)是最常见的感染部位,革兰阴性菌(29.9%)、革兰阳性菌(16.8%)和培养阴性菌(30.7%)是最常见的感染菌群。

94例再次入院的患者的(68.6%)感染部位与初次脓毒症住院的部位相同。19%的再入院患者证实是相同的感染部位和相同的生物所致。然而,考虑到培养阴性败血症的不确定性,由于同一生物体和同一个部位的感染可能导致多达53.2%的再入院率。

此项研究表明:在90天内因脓毒症重新入院的患者中,三分之二的患者与初次入院的感染部位相同。只有19%的感染与初始败血症住院是相同的感染部位和感染生物体。一半的再入院患者是新发感染,由于在住院治疗过程中的培养结果阴性,另外34%的患者的感染尚不清楚。

原始出处:
DeMerle KM, Royer SC, et al. Readmissions for Recurrent Sepsis: New or Relapsed Infection? Crit Care Med. 2017 Jul 22. doi: 10.1097/CCM.0000000000002626.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=229341, encodeId=c7852293415a, content=谢谢分享,很不错。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Wed Aug 02 23:35:43 CST 2017, time=2017-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=228342, encodeId=862022834253, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Jul 31 07:46:57 CST 2017, time=2017-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227265, encodeId=217e22e26520, content=.好办法,希望能治理好。., beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jul 28 15:37:18 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1516351, encodeId=dd581516351df, content=<a href='/topic/show?id=a5598519866' target=_blank style='color:#2F92EE;'>#脓毒症患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85198, encryptionId=a5598519866, topicName=脓毒症患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=dd7310955580, createdName=dlwang_26703130, createdTime=Fri Jul 28 09:14:00 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607885, encodeId=485c160e88543, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Fri Jul 28 09:14:00 CST 2017, time=2017-07-28, status=1, ipAttribution=)]
    2017-08-02 虈亣靌

    谢谢分享,很不错。

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=229341, encodeId=c7852293415a, content=谢谢分享,很不错。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Wed Aug 02 23:35:43 CST 2017, time=2017-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=228342, encodeId=862022834253, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Jul 31 07:46:57 CST 2017, time=2017-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227265, encodeId=217e22e26520, content=.好办法,希望能治理好。., beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jul 28 15:37:18 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1516351, encodeId=dd581516351df, content=<a href='/topic/show?id=a5598519866' target=_blank style='color:#2F92EE;'>#脓毒症患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85198, encryptionId=a5598519866, topicName=脓毒症患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=dd7310955580, createdName=dlwang_26703130, createdTime=Fri Jul 28 09:14:00 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607885, encodeId=485c160e88543, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Fri Jul 28 09:14:00 CST 2017, time=2017-07-28, status=1, ipAttribution=)]
    2017-07-31 ylzr123

    感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=229341, encodeId=c7852293415a, content=谢谢分享,很不错。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Wed Aug 02 23:35:43 CST 2017, time=2017-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=228342, encodeId=862022834253, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Jul 31 07:46:57 CST 2017, time=2017-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227265, encodeId=217e22e26520, content=.好办法,希望能治理好。., beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jul 28 15:37:18 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1516351, encodeId=dd581516351df, content=<a href='/topic/show?id=a5598519866' target=_blank style='color:#2F92EE;'>#脓毒症患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85198, encryptionId=a5598519866, topicName=脓毒症患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=dd7310955580, createdName=dlwang_26703130, createdTime=Fri Jul 28 09:14:00 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607885, encodeId=485c160e88543, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Fri Jul 28 09:14:00 CST 2017, time=2017-07-28, status=1, ipAttribution=)]
    2017-07-28 虈亣靌

    .好办法,希望能治理好。.

    0

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  5. [GetPortalCommentsPageByObjectIdResponse(id=229341, encodeId=c7852293415a, content=谢谢分享,很不错。, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Wed Aug 02 23:35:43 CST 2017, time=2017-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=228342, encodeId=862022834253, content=感谢小编为我们准备了如此丰盛的精神大餐,同时也向作者致谢!认真学习了,点赞!, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Mon Jul 31 07:46:57 CST 2017, time=2017-07-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=227265, encodeId=217e22e26520, content=.好办法,希望能治理好。., beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Fri Jul 28 15:37:18 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1516351, encodeId=dd581516351df, content=<a href='/topic/show?id=a5598519866' target=_blank style='color:#2F92EE;'>#脓毒症患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85198, encryptionId=a5598519866, topicName=脓毒症患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=dd7310955580, createdName=dlwang_26703130, createdTime=Fri Jul 28 09:14:00 CST 2017, time=2017-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1607885, encodeId=485c160e88543, content=<a href='/topic/show?id=eb6b1145939' target=_blank style='color:#2F92EE;'>#Med#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11459, encryptionId=eb6b1145939, topicName=Med)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=552a19396740, createdName=ms3994565386320060, createdTime=Fri Jul 28 09:14:00 CST 2017, time=2017-07-28, status=1, ipAttribution=)]

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Chest:重症监护室脓毒症1和脓毒症3的临床评估

脓毒症3诊断标准以敏感性为代价缩小了脓毒症人群,造成的假阴性可能会延迟疾病诊断。