Clinical Characteristics,Pathogens and Drug Resistance of 368 Patients with Bloodstream Infection
Objective The purpose of this research is to investigate the drug resistance,pathogen distribution,and clinical characteristics of patients with bloodstream infections(BSI)and to offer a resource for the prudent use of antibiotics.Methods Between July 2020 and June 2021,a total of 368 adult patients with BSI from two governmental hospitals in Shengzhou City were examined and classified into two groups:those who acquired their BSI in the community and those who acquired it in the hospital.The demographic data,clinical characteristics,and bacterial and drug sensitivity results of the patients were recorded.Results Intra-abdominal(38.6％),urinary tract(27.2％),and skin,soft tissue,bone,and joint(9.5％)were the top three causes of infection.7.3％,or 27 instances,had immunosuppression.47.0％,or 173 instances,have previously used antibiotics.The proportion of intra-abdominal sources in the community-acquired BSI group was higher than that in the hospital-acquired BSI group(P=0.010),the proportion of intravenous catheter source,immunosuppressive status,antibiotic exposure,APACHEII and PBS scores were lower(P＜0.05).A total of 379 strains of bacteria were detected,among which 108(28.5％)were Gram-positive cocci,247(65.2％)were gram-negative bacilli,13(3.4％)were anaerobes and 10(2.6％)were Candida.The top three bacteria were Escherichia coli,Klebsiella pneumoniae and Enterococcus,accounting for 30.1％,18.7％and 9.8％,respectively.The proportion of Escherichia coli in the community-acquired BSI group was higher(P＜0.001)while the proportion of Enterococcus,non-fermentable bacteria and Candida was lower(P＜0.05).Methicillin-resistant strains(MRSA)accounted for 43.3％.The resistance rates of Escherichia coli to ceftriaxone and Klebsiella pneumoniae to imipenem were 51.8％and 22.5％,respectively.Compared with the community-acquired BSI group,the resistance rate of Klebsiella pneumoniae in the hospital-acquired BSI group to ampicillin/sulbactam,piperacillin/tazobactam,ceftriaxone,ceftazidime,cefotetan,amtriannan,imipenem and tobramycin was higher(P＜0.05).309 cases(84.0％)were effective while 59 cases(16.0％)were ineffective.The 28-day mortality rate after bloodstream infection was 14.1％(52/368),and the mortality rate of the hospital-acquired BSI group was higher than that of the community-acquired BSI group(P＜0.05).In 35.5％(78/220)of the initial broad-spectrum antimicrobial treatment cases,the descending ladder strategy was implemented within 5 days,and the mortality rate in the descending ladder group was lower than that in the non-descending ladder group(P＜0.05).Conclusion The major pathogens in BSI in this region were Escherichia coli and Klebsiella pneumoniae.The percentage of non-fermentative bacteria,candida,and the resistance rate of Klebsiella pneumoniae was dramatically raised,and the 28-day death rate was also significantly elevated in hospital-acquired bloodstream infections(BSIs)compared to a considerable decrease in the proportion of Escherichia coli.The prevention and control of hospital infection should be strengthened,and the rational use of antibiotics should be improved.
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