Shinnosuke Fukushima: Department of General Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
Hideharu Hagiya: Department of General Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan. hagiya@okayama-u.ac.jp. ORCID
Koji Fujita: Department of General Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
Shinya Kamiyama: Department of General Medicine and Infectious Diseases, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama, 708-0841, Japan.
Haruto Yamada: Department of General Medicine, Okayama City Hospital, 3-20-1, Kitanagaseomote-cho, Kita-ku, Okayama-shi, Okayama, 700-8557, Japan.
Masayuki Kishida: Department of General Medicine, Okayama City Hospital, 3-20-1, Kitanagaseomote-cho, Kita-ku, Okayama-shi, Okayama, 700-8557, Japan.
Fumio Otsuka: Department of General Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kitaku, Okayama, 700-8558, Japan.
PURPOSE: To clarify the clinical and microbial characteristics of polymicrobial bacteremia (PMB) to contribute to improvements in clinical diagnosis and effective early treatment. METHODS: This retrospective multicenter study used data from three acute-care hospitals in Okayama Prefecture, Japan, collected between January 2014 and March 2019. We reviewed the demographics, comorbidities, organisms isolated, infectious focus, and 30-day mortality of patients with PMB. RESULTS: Of the 7233 positive blood cultures, 808 (11.2%) were positive for more than one organism. Of the patients with bacteremia, 507 (7.0%) had PMB, of whom 65.3% were male. Infectious foci were identified in 78.3% of the cases, of which intra-abdominal infections accounted for 47.1%. A combination of Gram-positive cocci (GPC) (chain form) and Gram-negative rods (GNR) accounted for 32.9% of the cases, and GPC/GNR and GNR/GNR patterns were significantly associated with intra-abdominal infections. The 30-day mortality rate of patients with PMB was 18.1%, with a median of 7.5 days from diagnosis to death. The mortality in patients with an infectious focus identified was significantly lower than that in patients with an unknown focus (16.3% vs. 24.5%; p = 0.031). CONCLUSIONS: Intra-abdominal infections were the most common source of PMB, and were strongly associated with a Gram-staining combination pattern of GPC (chain form)/GNR. PMB cases with an unknown focus had a poorer prognosis, highlighting the importance of early diagnosis and appropriate treatment.
Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect. 2013;19:501–9. https://doi.org/10.1111/1469-0691.12195 .
[DOI: 10.1111/1469-0691.12195]
Timsit JF, Ruppé E, Barbier F, Tabah A, Bassetti M. Bloodstream infections in critically ill patients: an expert statement. Intensive Care Med. 2020;46:266–84. https://doi.org/10.1007/s00134-020-05950-6 .
[DOI: 10.1007/s00134-020-05950-6]
Ngo JT, Parkins MD, Gregson DB, Pitout JDD, Ross T, Church DL, et al. Population-based assessment of the incidence, risk factors, and outcomes of anaerobic bloodstream infections. Infection. 2013;41:41–8. https://doi.org/10.1007/s15010-012-0389-4 .
[DOI: 10.1007/s15010-012-0389-4]
van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB. Predictors of mortality in staphylococcus aureus bacteremia. Clin Microbiol Rev. 2012;25:362–86. https://doi.org/10.1128/CMR.05022-11 .
[DOI: 10.1128/CMR.05022-11]
Ballouz T, Aridi J, Afif C, Irani J, Lakis C, Nasreddine R, et al. Risk factors, clinical presentation, and outcome of Acinetobacter baumannii bacteremia. Front Cell Infect Microbiol. 2017;7:156. https://doi.org/10.3389/fcimb.2017.00156 .
[DOI: 10.3389/fcimb.2017.00156]
Shankar-Hari M, Harrison DA, Rubenfeld GD, Rowan K. Epidemiology of sepsis and septic shock in critical care units: comparison between sepsis-2 and sepsis-3 populations using a national critical care database. Br J Anaesth [Internet]. 2017;119:626–36. https://doi.org/10.1093/bja/aex234 .
[DOI: 10.1093/bja/aex234]
Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019-results from a systematic review and meta-analysis. Crit Care Crit Care. 2020;24:1–9.
Goldman S, Itshaki O, Shochat T, Gafter-Gvili A, Yahav D, Rubinovitch B, et al. Risk factors and outcome of polymicrobial bacteremia: a retrospective cohort study. Isr Med Assoc J. 2020;22:279–84.
[PMID: 32378818]
Lin JN, Lai CH, Chen YH, Chang LL, Lu PL, Tsai SS, et al. Characteristics and outcomes of polymicrobial bloodstream infections in the emergency department: A matched case-control study. Acad Emerg Med. 2010;17:1072–9. https://doi.org/10.1111/j.1553-2712.2010.00871.x .
[DOI: 10.1111/j.1553-2712.2010.00871.x]
Bouza E, Burillo A, Muñoz P, Guinea J, Marín M, Rodríguez-Créixems M. Mixed bloodstream infections involving bacteria and Candida spp. J Antimicrob Chemother. 2013;68:1881–8. https://doi.org/10.1093/jac/dkt099 .
[DOI: 10.1093/jac/dkt099]
Sancho S, Artero A, Zaragoza R, Camarena JJ, González R, Nogueira JM. Impact of nosocomial polymicrobial bloodstream infections on the outcome in critically ill patients. Eur J Clin Microbiol Infect Dis. 2012;31:1791–6. https://doi.org/10.1007/s10096-011-1503-8 .
[DOI: 10.1007/s10096-011-1503-8]
Yo CH, Hsein YC, Wu YL, Hsu WT, Ma MHM, Tsai CH, et al. Clinical predictors and outcome impact of community-onset polymicrobial bloodstream infection. Int J Antimicrob Agents. 2019;54:716–22. https://doi.org/10.1016/j.ijantimicag.2019.09.015 .
[DOI: 10.1016/j.ijantimicag.2019.09.015]
Park SY, Park KH, Bang KM, Chong YP, Kim SH, Lee SO, et al. Clinical significance and outcome of polymicrobial Staphylococcus aureus bacteremia. J Infect. 2012;65:119–27. https://doi.org/10.1016/j.jinf.2012.02.015 .
[DOI: 10.1016/j.jinf.2012.02.015]
Wang YC, Ku WW, Yang YS, Kao CC, Kang FY, Kuo SC, et al. Is polymicrobial bacteremia an independent risk factor for mortality in Acinetobacter baumannii bacteremia? J Clin Med. 2020;9:153. https://doi.org/10.3390/jcm9010153 .
[DOI: 10.3390/jcm9010153]
Liu Q, Wu J, Wang Z, Wu X, Wang G, Ren J. Polymicrobial bacteremia involving Klebsiella pneumoniae in patients with complicated intra-abdominal infections: frequency, co-pathogens, risk factors, and clinical outcomes. Surg Infect (Larchmt). 2019;20:317–25. https://doi.org/10.1089/sur.2018.207 .
[DOI: 10.1089/sur.2018.207]
Han XY, Kamana M, Rolston KVI. Viridans streptococci isolated by culture from blood of cancer patients: clinical and microbiologic analysis of 50 cases. J Clin Microbiol. 2006;44:160–5. https://doi.org/10.1128/JCM.44.1.160-165.2006 .
[DOI: 10.1128/JCM.44.1.160-165.2006]
Weinstein MP. Current blood culture methods and systems: clinical concepts, technology, and interpretation of results. Clin Infect Dis. 1996;23:40–6. https://doi.org/10.1093/clinids/23.1.40 .
[DOI: 10.1093/clinids/23.1.40]
Rello J, Ricart M, Mirelis B, Quintana E, Gurgui M, Net A, et al. Nosocomial bacteremia in a medical-surgical intensive care unit: epidemiologic characteristics and factors influencing mortality in 111 episodes. Intensive Care Med. 1994;20:94–8. https://doi.org/10.1007/BF01707661 .
[DOI: 10.1007/BF01707661]
Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8. https://doi.org/10.1038/bmt.2012.244 .
[DOI: 10.1038/bmt.2012.244]
Al Majid F, Aldrees A, Barry M, Binkhamis K, Allam A, Almohaya A. Streptococcus anginosus group infections: management and outcome at a tertiary care hospital. J Infect Public Health. 2020;13:1749–54. https://doi.org/10.1016/j.jiph.2020.07.017 .
[DOI: 10.1016/j.jiph.2020.07.017]
Rhodes J, Jorakate P, Makprasert S, Sangwichian O, Kaewpan A, Akarachotpong T, et al. Population-based bloodstream infection surveillance in rural Thailand, 2007–2014. BMC Public Health. 2019;10:19–521. https://doi.org/10.1186/s12889-019-6775-4 .
[DOI: 10.1186/s12889-019-6775-4]
Schöneweck F, Schmitz RPH, Rißner F, Scherag A, Löffler B, Pletz MW, et al. The epidemiology of bloodstream infections and antimicrobial susceptibility patterns in Thuringia, Germany: a five-year prospective, state-wide surveillance study (AlertsNet). Antimicrob Resist Infect Control. 2021;10:132. https://doi.org/10.1186/s13756-021-00997-6 .
[DOI: 10.1186/s13756-021-00997-6]
Ruiz-Giardin JM, Ochoa CI, Velázquez RL, Jaqueti AJ, García Arat MI, SanMartín López JV, et al. Blood stream infections associated with central and peripheral venous catheters. BMC Infect Dis. 2019;19:1–841. https://doi.org/10.1186/s12879-019-4505-2 .
[DOI: 10.1186/s12879-019-4505-2]
Courjon J, Demonchy E, Degand N, Risso K, Ruimy R, Roger PM. Patients with community-acquired bacteremia of unknown origin: Clinical characteristics and usefulness of microbiological results for therapeutic issues: a single-center cohort study. Ann Clin Microbiol Antimicrob. 2017;16:40. https://doi.org/10.1186/s12941-017-0214-0 .
[DOI: 10.1186/s12941-017-0214-0]
