ヒライ ユウジ
  平井 由児
   所属   医学部 医学科(東京女子医科大学病院)
   職種   非常勤講師
論文種別 原著
言語種別 英語
査読の有無 査読あり
表題 Gram-negative rod bacteremia after cardiovascular surgery: Clinical features and prognostic factors.
掲載誌名 正式名:Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi
略  称:J Microbiol Immunol Infect
ISSNコード:19959133/16841182
掲載区分国外
巻・号・頁 50(3),333-338頁
著者・共著者 Kikuchi Ken, Tago Sayaka, Hirai Yuji, Ainoda Yusuke, Fujita Takahiro
発行年月 2017/06
概要 BACKGROUND/PURPOSE:Our aim was to describe the clinical features and prognostic factors of Gram-negative rod bacteremia (GNRB) after cardiovascular surgery (CVS).METHODS:This retrospective observational study included adults with GNRB onset within 100 days after CVS at a single institution from April 2004 to May 2013. Clinical data regarding episodes of GNRB were collected from patients' medical charts. Those having polymicrobial bacteremia with a bacterium other than a GNR were excluded.RESULTS:Among 2017 CVS patients, GNRB occurred in 78. Klebsiella, Pseudomonas aeruginosa, Enterobacter, and Escherichia coli were the most commonly isolated organisms. Graft replacement was the most common surgical procedure in patients with GNRB after CVS (44.9%). Prophylaxis antibiotics were ampicillin/sulbactam (76.9%), and vancomycin (12.8%). The crude 90-day mortality rate was 21.8%, and the mean Acute Physiology and Chronic Health Evaluation II score was 15.6 (range, 3-39). In 34.6% of patients, the same GNR species were isolated from other samples within 30 days of GNRB occurrence. Multivariate analysis indicated that P. aeruginosa bacteremia [odds ratio (OR), 175; confidence interval (CI), 2.40-1270; p = 0.0182], Acute Physiology and Chronic Health Evaluation II scores of ≥ 25 (OR 76.2; CI 1.04-5580; p = 0.0479), and vancomycin for prophylaxis (OR 45.4; CI 1.02-202; p = 0.0488) were significant independent prognostic factors associated with death due to GNRB after CVS.CONCLUSION:Graft replacement was the most common surgical procedure in patients with GNRB after CVS. Empirical antibiotics covering Gram-negative rods including P. aeruginosa should be considered if bacteremia is suspected in unstable patients after CVS.
DOI 10.1016/j.jmii.2015.07.008
PMID 26323362