| [Objective]In order to evaluate the clinical and microbial characteristics of bloodstream infection, including the underlying state of the patients, clinical manifestations, microbial spectrum, and prognosis as well as the affecting factors, at Peking Union Medical College Hospital in these years, we conducted the retrospective part of the study, trying to explore the association of the state of patients with the clinical manifestation and prognosis.[Methods]Retrospectively, we collected the data of the patients with definite BSI, including clinical data microbial data, using standard chart that designed previously. SPSS software was used in the data analysis.[Results]Totally we included927cases of bloodstream infection,92.7%of whom were with chronic underlying diseases or the diseases needing long-term hospitalization. One hundred and ninety-one (20.6%) patients with polymicrobial bloodstream infection, we isolated1186strains of microbe from the positive blood cultures in927patients,77.2%being hospital acquired. The five most common isolates were coagulase-negative staphylococcus (23.5%), E.coli (18.2%), Enterococcus spp.(10.9%), Acinetobacter spp.(9.5%) and Staphylococcus Aureues (8.7%), while the G+cocci and the G-rods were comparable. Candida spp. accounting for84.5%, seventy-one isolate of fungi were isolated. According to the sources of bloodstream infection, primary bloodstream infection was the most common, followed by bloodstream infection secondary to abdominal infection, bloodstream infection secondary to lower respiratory tract infection and central-line associated bloodstream infection. There were254patients died during hospitalization with a crude mortality rate of27.4%. Among the927cases,210complicated with severe sepsis and septic shock, however, another159cases, about half of who didn't receive appropriate antibiotic treatment, only underwent a transient sepsis. The patients who complicated severe sepsis and septic shock were with a higher mortality rate (OR=20.41;95%CI,13.93-29.915; χ2=318.60, P=0.000). In the multivariate analysis, chronic lung diseases, diseases of central nervous system, reservation of central-line, invasive mechanical ventilation, age≥65years old, ICU treatment and polymicrobial bloodstream infection were the independent risk factors of poor prognosis, but the operation history within30days was inverse correlated to poor prognosis.[Conclusions]Almost all the patients underwent bloodstream infection had at least one type of chronic underlying disease or the disease need long hospitalization, which may lay the patients in different immune states. Some patients experienced only a transient sepsis, while some manifested as severe sepsis and septic shock, due to the different immune states of the patients. [Objective]In order to find the immune differences between septic patients and severe septic patients, as well as septic patients and non-infective SIRS patients, we evaluate the subgroups of lymphocytes, proinflammatory cytokines and suppressive inflammatory factors between these patients.[Methods]In the prospective part of the study, we included the septic and severe septic and septic shock patients due to bloodstream infection, noninfective SIRS patients due to malignant disease or system arteritis. Evaluate the subgroup of lymphocytes and cytokines and chemokines by flow cytometry and CBA,[Results]In the cross-sectional study, prospectively, we included12cases with sepsis,12cases with severe sepsis and septic shock due to definite bloodstream infection. Simultaneously, we included11patients with non-infective SIRS due to lymphoma and arteritis as the control group. By comparison, there was no difference in the absolute counts in peripheral white blood cells, but the patients in severe septic group were with a lower lymphocyte percentage. There were no difference in the percentage and absolute counts of CD3+T cell, CD4+T cell, CD8+T cell, as well as B lymphocytes, but all the subgroups of lymphocytes mentioned above were lower than healthy patients. Both the percentage [10.15(7.70,15.35),4.35(2.05,8.05) vs.8.60(4.10,18.10), P=0.041] and absolute counts [114(56,165),50(14,73),103(59,167) cells/mm3; P=0.018] of NK cell were lower in the severe sepsis and septic shock patients. As the percentage of NKT/CD3+T, the patients with severe sepsis and septic shock were higher than the patients with sepsis [7.55(4.60,27.70) vs2.45(1.32,4.56), P=0.013].The level of plasma IL-6, IL-8, INF-γ, MCP-1, IP-10, MIG, IL-10were higher in septic group, severe sepsis and septic shock group as well as the non-infective SIRS group than healthy controls. But the level of plasma RANTES were lower in the SIRS patients than healthy controls. The level of plasma MIG [3306.20(285.80,8732.34) vs.383.70(165.29,651.86) pg/ml, P=0.018], IP-10[2269.67(1568.71,2921.59) vs.883.32(621.91,1536.92) pg/ml, P=0.010] and INF-y[64.00(39.20,83.35) vs.33.99(8.29,70.06) pg/ml, P=0.001] were higher in the patients non-infective SIRS than the patients with sepsis, which may be potentially as the biomarkers to discriminate sepsis and non-infective SIRS when the clinical manifestations were similar to each other. IL-8[63.41(35.21,95.85) vs.169.02(103.01,302.46), P=0.025] and MCP-1[143.00(71.77,410.30) vs.356.22(260.42,549.26), P=0.016] were higher in the severe sepsis group than sepsis group. The level of plasma IL-6[365.57(136.99,424.22) vs.40.52(31.56,131.60) pg/ml, P=0.028] and MIG [1816.18(1027.63,2562.66) vs.94.51(23.30,2803.72) pg/ml, P=0.018] were related to prognosis in the patients with severe sepsis and septic shock, which were higher in the patients who were died due to bloodstream infection than the survivors. High level of IL-6and MIG in the early stage of severe sepsis and septic shock indicated a bad prognosis.[Conclusion]The patients with severe sepsis were with lower lymphocytes than the patients with sepsis, and the reduction of NK cell was the most prominent. However, the percentage of NKT like cell/CD3+T cell in patients with severe sepsis was higher than that in patients with sepsis. IL-8and MCP-1were higher in patients with severe sepsis than the patients with sepsis. The plasma level of MIG and IL-6were higher in the patients who died due to severe sepsis than survivors. Having the potential to be the discriminated biomarkers, the plasma level of MIG, IP-10and INF-γ in the patients with non-infective SIRS were higher than the patients with sepsis.
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