Clinical Characteristics And Etiological Analysis Of Adult Patients Bloodstream Infection In Puyang Area From 2017 To 2019

BackgroundBloodstream infection（BSI）refers to an infection in which pathogenic microorganisms invade the bloodstream and can spread with the blood.In recent years,the incidence and fatality rate of BSI have increased year by year,BSI is divided into nosocomial bloodstream infection（NBSI）and community acquired bloodstream infection（CABSI）.It is different in different regions,at different periods,and the application of antibacterial drugs.The pathogens are very different,and the common pathogens of CABSI and NBSI are also different.ObjectiveThis study explores the clinical and pathogenic characteristics of patients with bloodstream infections in this region from 2017 to 2019,and compares the similarities and differences between CABSI and NBSI in clinical and pathogenic characteristics,and provides a reliable basis for the diagnosis and treatment of BSI patients and the precise selection of antibacterial drugs.MethodsRetrospectively collect clinical data,bacterial culture results and drug sensitivity data of inpatients with positive blood cultures and confirmed bloodstream infections in Puyang People’s Hospital from January 2017 to December 2019,and perform statistical analysis.Microbial cultivation is completed by the laboratory of our hospital.The Bact/ALERT3D360 automatic blood culture system of Mérieux,France is used,and the BRUKER-MS flight mass spectrometer is used for bacterial identification.Statistical analysis was performed using SPSS23.0 software.The measurement d ata of skewed distribution is represented by M(P₂₅,P₇₅),and the rank sum test is used for comparison between groups;count data was expressed as rate（%）,and Ch i-square test and Fisher’s exact test were used for comparison between groups.Result1.BSI results（1）Clinical characteristics:Among the 632 adult patients diagnosed with BSI,men accounted for 55.7%,aged 18-95 years old,and older than 60 years old accounted for58.3%.The top five departments for the incidence of BSI:Intensive Care Unit（ICU）（37.3%）,Infectious Diseases Department（16.0%）,Gastroenterology（12.5%）,Hematology（9.3%）,Nephrology 54 cases（15.4%）.529 cases（83.7%）had underlying diseases,277cases（43.8%）had invasive procedures,and 142 cases had worsened and died.The case fatality rate was 22.5%.（2）Pathogen distribution:In this study,the positive rate of blood culture was 11.7%,and 675 strains with positive bleeding stream infection were screened.Gram-negative strains accounted for 76.7%,Gram-positive bacteria 17.2%,and fungi 6.1%.The top five bacteria in the pathogenic bacteria:Escherichia coli 32.1%,Klebsiella pneumoniae 25.0%,Staphylococcus aureus 5.9%,Streptococcus 5.8%,Enterococcus 4.3%.There were 39cases of multiple bacterial infections,of which 45.7%were multi-drug resistant bacteria and 71.9%were patients in the intensive care unit.A total of 128 strains（19.0%）of multi-drug resistant bacteria were detected.（3）Resistance of main bacteria:Escherichia coli is highly sensitive to carbapenem antibiotics.Klebsiella pneumoniae is resistant to carbapenem drugs above 20%,while it is resistant to amikacin,tobramycin,and levofloxacin Star has a low drug resistance rate of about 10%.2.Comparison of CABSI and NBSI（1）Comparison of clinical characteristics:There was no statistically significant difference in gender between the CABSI group and the NBSI group（P>0.05）;the difference in the distribution of the two groups in the departments was statistically significant（P<0.05）:the CABSI group was evenly distributed in each general department,and more than half of the NBSI group was in severe cases Intensive care unit;the CABSI group had lower rates of age,combined underlying diseases,invasive procedures,and fatality rates than the NBSI group,and the differences were statistically significant（P<0.05）.（2）Pathogen comparison:The CABSI group and NBSI had a statistically significant difference in the distribution of pathogens（P<0.05）.The top five pathogens in CABSI were:Escherichia coli（41.2%）,Klebsiella pneumoniae（20.2%）,Brucella Bacillus（7.2%）,Staphylococcus aureus（6.6%）,Streptococcus（5.5%）;NBSI’s top five pathogens are:Klebsiella pneumonia（30.7%）,Escherichia coli（19.2%）),Streptococcus（6.1%）,Enterococcus（6.1%）,Staphylococcus aureus（5.1%）.The probability of fungal infection in the CABSI group was lower than that in the NBSI group.Thee was no statistically significant difference between the two groups in the probability of multiple bacterial infection and the probability of multi-drug resistance（P>0.05）.Conclusion1.More than half of adults with BSI were older than 60 years old,and they were more common in men,most of which were accompanied by underlying diseas es.More than 90%of NBSI had invasive procedures.There was no difference in g ender between CABSI and NBSI.CABSI was lower than NBSI in terms of age,in cidence of underlying diseases,incidence of invasive procedures,and mortality.2.From 2017 to 2019,the main pathogens of adult BSI in Puyang in this area were Gram-negative bacteria,mainly Escherichia coli and Klebsiella pneumoniae.CABSI has the most Escherichia coli,and NBSI has the most Klebsiella pneumoniae.There was no difference between CABSI and NBSI in the probability of multi-bacteria infection and multi-drug resistance.3.Escherichia coli and Klebsiella pneumoniae have a high resistance rate to Ceftriaxone,Escherichia coli is highly sensitive to carbapenem drugs.The resistance rate of Klebsiella pneumoniae to hydrocarbons is more than 20%,but the resistance rate to amikacin,tobramycin,and levofloxacin is within 10%.