Prognostic Evaluation Of Patients With Enterobacteriaceae Bloodstream Infection With Sepsis

Background Bloodstream infections and sepsis caused by bloodstream infections are one of the leading causes of death in hospitalized patients.For a long time,reducing the incidence of sepsis,improving the prognosis of patients with sepsis,and reducing the mortality rate have been the core goals of the "Surviving Sepsis Campaign".Hematogenous infections are the result of the spread of various primary or seco ndary infections.Severe bloodstream infections cause sepsis and septic shock..Hematogenous infections can be found in Staphylococcus aureus,Enterobacteriaceae Streptococcus pneumoniae,Pseudomonas aeruginosa,Klebsiella pneumoniae,etc.Escherichia coli,K lebsiella pneumoniae are the most common Enterobacteriaceae that causing bloodstream infections,while both of them are opportunistic pathogens.A large number of studies have also shown that the prognosis of patients with sepsis is related to the virulence and type of pathogens.At present,there are few reports on the prognosis of patients with sepsis in enterobacteriaceae.This research is dedicated to exploring the prognostic risk factors that affect patients with sepsis due to bloodstream infection caused by the same type of pathogens.At the same time,this study introduced the Pitt bacteremia score(PBS score)system to to explore the evaluation value of PBS scores in the prognosis of patients with sepsis caused by enterobacteriaceae bloodstream infection.And this study is expected to provide a reference for reducing the mortality and improving the prognosis of patients with sepsis.Objective To investigate the clinical characteristics and the prognostic risk factors in patients with sepsis caused by Enterobacteriaceae bloodstream infection.Methods The medical records of patients with sepsis caused by Enterobacteriaceae bloodstream infection in Q ingdao Municipal Hospital were screened retrospectively from June 2017 to May 2019.and the gender,age,admission department,basic disease,infection site,etiology examination and initial empirical treatment plan were recorded in detail.The survival and death groups were divided according to their survival condition for 28 days.The ratio of C-reactive protein(CRP)to serum prealbumin(PA)was recorded within 24 hours after admission.And the acute physiological and chronic health scores(APAC HE II score)and Pitt bacteremia score(PBS score)were calculated within 24 hours,and based on the results of b lood culture drug sensitivity test to analyze whether the initial experience treatment is appropriate.The Logistic regression equations were used to analyze the risk factors affecting the prognosis of patients,The Sperman correlation analysis was used to study the correlation between risk factors and severity of the disease,and the Receiver Operating Characteristic curve(ROC curve)was drawn to predict the occurrence of adverse prognosis in patients with sepsis.Results 1.The results of logistic regress ion univariate analysis showed that C-reactive protein(OR: 1.021,P <0.01),CRP / PA(O R: 34.638,P <0.01),extended-spectrum ?-lactamase production(OR: 0.244,P <0.01),Inappropriate empirical antibacterial treatment(OR: 0.156,P <0.01),APACHE II score(OR: 1.436,P <0.01),and PBS score(OR: 8.622,P <0.01)are risk factors that affect patients' poor prognosis.2.The results of multivariate regression analysis showed CRP / PA(O R: 25.420,P <0.05),inappropriate empirical treatment(OR: 0.077,P <0.05),APACHE? score(OR: 1.476,P <0.01),PBS score(OR: 12.042,P <0.01)were independent risk factors for death in patients with sepsis(P <0.05).3.The results of Sperman correlation analysis showed that inappropriate empirical treatment(? = 0.376,P <0.01),CRP / PA(? = 0.440,P <0.01),PBS score(? = 0.529,P <0.01),All were significantly correlated with APAC HE? score,that is to say,the level of CRP / PA,PBS score,APACHE? score were positively correlated with the severity of the disease.4.The higher the C RP/PA level,the higher the PBS score and the APAC HE II score indicated that the patients' prognosis is worse.When CRP/PA?0.89,PBS score?3.5,APACHEII score?17.5,the risk of death is significantly increased.In addition,inappropriate empirical treatment is also a key factor in patients with poor prognosis.Conclusion 1.CRP/PA,PBS score,APACHE II score,and inappropriate empirical treatment are independent risk factors affecting the death of patients with enterobacteriaceae hemorrhagic infection with sepsis.,PBS score and APAC HE? score When CRP / PA ? 0.89,PBS score ? 3.5,APACHE? score ? 17.5,the risk of death is significantly increased.The level of C RP / PA ratio,PBS score,APACHE? score are closely related to the severity of the disease,when CRP / PA ? 0.89,PBS score ? 3.5,APACHE II score ? 17.5,the risk of death was significantly increased.2.The PBS score can better predict patients' bad prognosis and risk of death.Compared with APACHEII,the former is simpler and more practical,so it can be widely used,but it is not a substitute for APACHEII scoring system.