The Clinical Analysis Of 4939 Episodes Of Bloodstream Infection

Part ?The distribution of pathogens in bloodstream infectionObjective To investigate the distribution of pathogens isolated from patients with bloodstream infection in the First Affiliated Hospital of Soochow University from January 1,2003 to December 31,2016.Methods Retrospective analysis was performed by collecting data of demographic data,underlying diseases,distribution of all cases in clinical departments and blood culture results in the First Affiliated Hospital of Soochow University from January 1,2003 to December 31,2016.Results There were 4939 patients enrolled in our study in total,male: female=3016: 1923,with mean age of(52±20)years old.Most bloodstream infection(BSI)patients were from hematology department(n=1731,35.05%),followed by ICU(n=794,16.08%),digestive department(n=281,5.69%)and infection department(n=273,5.53%).4690 strains of bacteria and 249 strains of fungi were isolated in all.The proportion of gram-negative bacilli,gram-positive cocci,gram-positive bacilli,gram-negative cocci and unclassified gram-positive bacteria were 47.54%,42.80%,4.43%,0.12%,and 0.07% respectively.The most common pathogen causing BSI was CNS(n=1286,26.04%),followed by E.coli(n=874,17.70%).The most common isolates of gram-negative bacilli were Escherichia and Klebsiella spp.Among gram-positive cocci,Staphylococcus(71.81%)ranked as the highest one.The gram-positive bacillus mainly included Coryne bacterium(15.98%)and Bacillus(8.22%).The gram-negative cocci only contained two kinds of bacteria,Catarrhalis(n=6)and Veillonellaparvula(n=1).As to fungi,Candida spp(n=217)was the most common one,including Candida albicans(n=96,38.55%),Non-albicans candida(n=117,46.99%).Generally speaking,the pathogens isolated from bloodstream increased year by year since 2003.The number of gram-positive bacteria and fungi increased yearly from 2003 to 2014,but showed a downward tendency in recent three years.The detection rate of gram-positive bacteria declined in general.The proportion of fungi kept in steady state in nearly eight years.The separation rate of gram-negative bacteria rose slightly.Conclusions Male patients are more susceptible to bloodstream infection than female ones.Bloodstream infection occurs more often in hematology department and ICU.The isolating rate of Gram-negative bacilli is higher than gram-positive cocci.CNS is the most common kind of pathogen,followed by E.coli.The number of fungi,gram positive bacteria and gram-negative bacteria increase year by year.Part ?The Clinical Analysis of 171 Episodes of Acinetobacter baumannii Bloodstream InfectionObjective To improve the knowledge of Acinetobacter baumannii bloodstream infection(BSI)via exploring the baseline features,clinical manifestation,therapy and prognosis of Acinetobacter baumannii BSI patients admitted to the First Affiliated Hospital of Soochow University from January 1,2003 to December 31,2016.Methods Retrospective analysis was performed by collecting data of baseline features,underlying diseases,temperature at blood drawing,counts of white blood cells,venous catheterization,antibacterial susceptibility,therapy and prognosis of Acinetobacter baumannii bloodstream infections in the First Affiliated Hospital of Soochow University from January 1,2003 to December 31,2016.Results There were 171 patients of Acinetobacter baumannii BSI in total(male: female = 105: 66),with mean age of(53±19)years old.The mainly underlying diseases were hematological malignancies(n=42),malignant solid tumor(n=28)and trauma(n =25).153 patients had fever.There were 37 patients(15.88%)with granulocytopenia and 25 patients with agranulocytosis.73 patients had venous catheterization when blood culture were performed,45 of them were positive for Acinetobacter baumannii.The susceptibility rate of Amikacin was 37.43%,followed by cefperazone-sulbactam(31.00%).50 strains were multidrug-resistant(MDR).Most patients received cefperazone-sulbactam and imipenem.98 patients(57.31%)improved after therapy.Conclusions Acinetobacter bauannii bloodstream infection occurs more often in immunocompromised hosts,such as hematological malignancies and malignant solid tumors.Venous catheterization and agranulocytosis are risk factors causing Acinetobacter bauannii bloodstream infection.Fever is a common symptom and warning signal for those patients.Acinetobacter bauannii are resistant to most parts of antibiotics.The prognosis of Acinetobacter baumannii bloodstream infection is very poor.Part ?Clinical Analysis of 233 Patients with Entercoccus Bloodstream InfectionObjective To explore the clinical features of patients with Entercoccus bloodstream infection.Methods The underlying diseases,temperature at blood sampling,results of routine blood tests,venous catheterization,antibacterial susceptibility,therapy and prognosis of 157 patients with Entercoccus bloodstream infection were retrospectively analyzed in the First Affiliated Hospital of Soochow University from January 1,2003 to December 31,2016.Results There were 233 patients of Entercoccus BSI in total(male: female = 155: 78),with mean age of(61±18)years old.The mainly underlying diseases were malignant solid tumor(n=68),hematological malignancies(n=35)and pulmonary infection(n=23).210 patients(90.13%)had fever.41 patients(17.60%)were leukopenia,and 37 patients(15.88%)were granulocytopenia,of whom 33 patients were agranulocytosis.Among the 233 cases,127(54.51%)were due to Enterococcus faecalis,93(39.91%)were due to Enterococcus faecium;the number of Enterococcus gallinarum,Enterococcus avium,Enterococcus raffinosus,Enterococcus casseliflavus and Enterococcus intestine were 3,3,3,2,2,respectively.There were 80 patients with venous catheterization when blood culture was performed,26 patients of who were positive for Entercoccus BSI.Vancomycin,linezolid and teicoplanin-resistant strains were 18,12 and 12,respectively.The resistance rate of Enterococcus faecium was higher than Enterococcus faecalis to Penicillin,Ampicillin,Gentamicin,Erythromycin,Ciprofloxacin(90.55%,90.55%,51.97%,92.31%,92.91% VS 72.10%,69.53%,51.50%,90.74%,5.97%).Most patients received vancomycin,linezolid or teicoplanin therapy and 155 patients(66.52%)improved.Conclusion Immune compromise and impairment of mucosal barrier function caused by underlying diseases,venous catheterization and agranulocytosis are the predisposing factor for Entercoccus bloodstream infection.Fever is one of the most common symptoms and warning signals.The resistance rate of enterococcus is very high,especially for enterococcus faecium.Vancomycin,linezolid and teicoplanin are the mainly antibiotics for Entercoccus bloodstream infection.