부산대학교 도서관

Background: Community acquired bacteremia (CAB) is a common cause of sepsis in low and middle-income countries (LMICs). However, knowledge about factors associated with outcomes of CAB in LMICs is limited. Methodology/Principal findings: A prospective observational study (Ubon-sepsis) of adults admitted to a referral hospital with community-acquired infection in Northeastern Thailand was conducted between March 1, 2013 and February 1, 2017. In the present analysis, patients with a blood culture collected within 24 hours of admission that was positive for one of the three most common pathogens were studied. Clinical features, management, and outcomes of patients with each cause of CAB were compared. Of 3,806 patients presenting with community-acquired sepsis, 155, 131 and 37 patients had a blood culture positive for Escherichia coli, Burkholderia pseudomallei and Staphylococcus aureus, respectively. Of these 323 CAB patients, 284 (89%) were transferred from other hospitals. 28-day mortality was highest in patients with B. pseudomallei bactaeremia (66%), followed by those with S. aureus bacteraemia (43%) and E. coli (19%) bacteraemia. In the multivariable Cox proportional hazards model adjusted for age, sex, transfer from another hospital, empirical antibiotics prior to or during the transfer, and presence of organ dysfunction on admission, B. pseudomallei (aHR 3.78; 95%CI 2.31–6.21) and S. aureus (aHR 2.72; 95%CI 1.40–5.28) bacteraemias were associated with higher mortality compared to E. coli bacteraemia. Receiving empirical antibiotics recommended for CAB caused by the etiologic organism prior to or during transfer was associated with survival (aHR 0.58; 95%CI 0.38–0.88). Conclusions/Significance: Mortality of patients with CAB caused by B. pseudomallei was higher than those caused by S. aureus and E. coli, even after adjusting for presence of organ dysfunction on admission and effectiveness of empirical antibiotics received. Improving algorithms or rapid diagnostic tests to guide early empirical antibiotic may be key to improving CAB outcomes in LMICs. Author summary: Bloodstream infections are very common and associated with significant numbers of death and disability around the world. Less is known about the rates, risks and impact of common bloodstream infections in low and middle-income countries. We conducted a large prospective four-year observational study in northeastern Thailand of persons admitted to a tertiary-care hospital with severe infections and analyzed those who had bloodstream infections. The three most common bacteria causing bloodstream infections were Escherichia coli, Burkholderia pseudomallei and Staphylococcus aureus. Most of the patients were transferred from other hospitals. Overall mortality was 41%. The highest mortality was among those who had B. pseudomallei infection, at 66%, and the lowest mortality was among those who had E. coli infection, at 19%. If appropriate antibiotics were given early, i.e. prior to or during the transfer, this was associated with survival. Our large study was able to identify the types, risk factors and impact of bloodstream infections in a low and middle-income country. These important results highlight the need for the development and implementation of rapid diagnostic tests and hospital algorithms for early diagnosis to improve care and outcomes of bloodstream infections in low and middle-income countries. [ABSTRACT FROM AUTHOR]