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국내 지역사회 3차 병원에서 최근 2년간 경험한 지역사회 균혈증의 원인과 예후에 관한 분석

Analysis on the Etiology and Prognostic Factors of Community-Acquired Bacteremia in a Community-Based Tertiary Hospital

감염과화학요법 2005년 37권 5호 p.255 ~ 264
박상원, 박주원, 이순일,
소속 상세정보
박상원 ( Park Sang-Won ) - 단국대학교 의과대학 내과학교실
박주원 ( Park Ju-Won ) - 단국대학교 의과대학 진단검사의학과
이순일 ( Lee Soon-Il ) - 단국대학교 의과대학 내과학교실

Abstract


Background: We conducted this study to describe the epidemiology of community-acquired bacteremia and identify its prognostic factors.

Materials & Methods: All patients admitted to a community-based tertiary hospital with community-acquired bacteremia from June 2002 to May 2004 were included and analyzed retrospectively.

Results: During the study period, clinically significant community-acquired bacteremia occurred in 223 patients with the frequency of 5.3 patients per 1,000 patient-admission. The commonly isolated organisms were E. coli (47.1%), K. pneumoniae (13.0%), S. aureus (8.1%), and S. pneumoniae (4.5 %). The leading source of bacteremia were urinary tract infection (34.5%), intraabdominal infection (33.6%), primary bacteremia (10.3%), and skin & soft tissue infection (8.1%). The overall mortality was 17%. S. aureus (34.8%) and K. pneumoniae (30.4%) were two major organisms of primary bacteremia with high case fatality of 50% and 28.6%, respectively. Univariate analysis showed that the followings were associated with significant increase in mortality: male patient; S. aureus and other streptococci bacteremia; increasing APACHE II score; definite diagnosis after 3 days of admission; inappropriate antibiotics therapy within 24 hours of admission; emergency room; admission to ICU. The independent predictors of mortality were male patient (RR 3.02, P=0.031), increasing APACHE II score (RR 1.12, P=0.011), and admission to ICU (RR 9.73, P<0.001).

Conclusion: Rapid definite diagnosis and prompt administration of appropriate antibiotics according to the local epidemiologic pattern are the most important controllable factors for the better outcome.

키워드

Community-Acquired Bacteremia;Etiology;Prognosis

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