Clinical Characteristics And Prognostic Risk Factors Of Blood Culture-positive Sepsis Patients

Objective The clinical characteristics were analyzed to explore the risk factors related to the death in sepsis patients with positive blood culture.Methods Retrospective analysis of clinical data of patients with blood culture-positive sepsis from December 2016 to December 2018 in our hospital(including age,gender,underlying disease,infection site,Invasive operation,admission SOFA score,APACHE? score,PCT value,CRP value,pathogenic bacteria type,drug sensitivity results,etc.),divided into survival group and death group according to the 30-day prognosis.Descriptive statistical analysis was used to study the clinical characteristics of patients,single-factor and multiple factors Logistic regression analysis are conducted to analyze the risk factors related to the death.Results1.A total of 343 blood culture-positive sepsis patients were included in this study,the mortality rate within 30 days was 20.99%,and the proportion of patients over 60 years old was higher(52.48%).The main infection sites were respiratory system(39.06%),urinary system(22.16%)and biliary tract infection(7.29%).Most common underlying diseases were diabetes(14.58%),followed by solid organ tumors(9.33%)and neoplastic hematologic disorder(3.79%).Indwelling catheterization(30.61%),central venous catheterization(15.16%),and endotracheal intubation/tracheotomy(15.16%)were used in invasive treatment.The admission SOFA score,APACHE ? score and PCT values of the death group were higher than those of the survival group,with statistically significant differences(P<0.05).2.Pathogen characteristics: the proportion of gram-negative bacteria,gram-positive bacteria and fungi were 75.51%,20.99% and 0.87% respectively.The main gram-positive bacteria were staphylococcus aureus(7.29%)and enterococci(3.50%).The main gram-negative bacteria were escherichia coli(44.90%),klebsiella pneumoniae(16.91%),enterobacter cloacae(3.21%),acinetobacter baumannii(2.92%)and pseudomonas aeruginosa(2.04%).Acinetobacter baumannii is the main multidrug-resistant bacterium and just sensitive to minocycline.Gram-negative bacteria(except acinetobacter baumannii)were sensitive to amikacin,carbapenems and piperacillin tazobactam.Gram-positive bacteria were sensitive to vancomycin,tigacycline,linezolid.Candida albicans is the main pathogen of fungal infection.3.Risk factors of death in sepsis patients with positive blood culture:In the single-factor analysis,the differences in admission SOFA score,APACHE ?>15,PCT value,endotracheal intubation/tracheotomy,escherichia coli infection,and acinetobacter baumannii infection between the two groups were statistically significant(P<0.05).Multivariate logistic regression analysis concluded that SOFA score,APACHE ?>15,PCT value,and endotracheal intubation/tracheotomy were independent risk factors for death in blood culture-positive sepsis patients(P<0.05).Conclusion1.The main population of sepsis patients with positive blood culture is the elderly;the most common infection sites was respiratory;the primary diseases were diabetes mellitus;the mainly pathogenic bacteria of sepsis patients with bloodstream infections were gram-negative bacilli;the most common pathogenic bacteria is escherichia coli;the main multidrug-resistant pathogen is acinetobacter baumannii.2.The admission SOFA score,APACHE?>15 points,PCT value,endotracheal intubation/tracheotomy is affecting blood culture positive for independent risk factors related to death in patients with sepsis.