Avtor/Urednik		Trampuž, Andrej
Naslov		Analysis of 405 episodes of pneumococcal bacteremia in adults over a 15-year period
Prevedeni naslov		Analiza 405 primerov pnevmokokne bakteriemije pri odraslih v obdobju 15 let
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 71, št. 10
Leto izdaje		2002
Obseg		str. 607-14
Jezik		eng
Abstrakt		Background. HIV-infection and increasing drug resistance may influence the prognosis of pneumococcal bacteremia. We performed an observational cohort study to analyze the epidemiology, risk factors, and outcome for pneumococcal bacteremia during a 15 year period. Methods. Charts were reviewed from hospitalized adults at the University Hospital Basel, Switzerland, whose blood culture yielded Streptococcus pneumoniae in the period from January 1986 through December 2000. Results. 405 episodes of pneumococcal bacteremia in 394 patients were identified. The mean annual incidence was 1.78 episodes per 1, 000 hospital admissions. Most common risk factors were cigarette smoking, chronic lung disease, malignancy, and alcohol misuse. HIV-infection was known in 46 episodes (11%). During the study period, the nonsusceptibility of pneumococci against penicillin increased from 0% to 17%. The overall mortality was 25%. The case-fatality rate decreased from 32% to 17% during the second half of the study period (P <0.001). Independent risk factors for fatal outcome were coronary heart disease, neutropenia, and increasing age, whereas prior respiratory infection and the occurrence of bacteremia in the second half of the study period were independent predictors of survival. Mortality in HIV-infected patients was lower than in HIV-noninfected subjects (9% versus 27%, P = 0.007). Conclusions. Despite increased numbers of penicillin-nonsusceptible strains, mortality of pneumococcal pneumonia significantly decreased in the second half of study period.
Izvleček		Izhodišča. Streptococcus pneumoniae je pomemben povzročitelj obolevnosti in smrtnosti po vsem svetu. Kljub učinkovitim antibiotikom in cepivu je smrtnost pnevmokokne bakteriemije ostala visoka kot pred 50 leti. Vzrok je lahko vse starejša populacija z vse pogostejšimi osnovnimi obolenji ali bolj imunsko oslabljeni bolniki, kot so na primer bolniki s presajenimi organi ali okuženimi z virusom človeške imunske pomanjkljivosti (HIV). Poleg tega so se pojavili manj občutljivi in popolnoma odporni sevi S. pneumoniae, kar bi lahko neugodno vplivalo na prognozo pnevmokokne bakteriemije. V ta namen smo opravili retrospektivno opazovalno kohortno raziskavo, v kateri smo proučevali epidemiologijo, dejavnike tveganja za nastanek bolezni, protimikrobno občutjivost osamljenih povzročiteljev in izhod pnevmokokne bakteriemije v obdobju 15 let. Metode. Pregledali smo popise bolezni vseh odraslih bolnikov v starosti >=18 let s pozitivnimi krvnimi kulturami z bakterijo S. pneumoniae, ki so bili od januarja 1986 do decembra 2000 sprejeti v Univerzitetno bolnišnico Basel, Švica. Pozitivne krvne kulture iz Inštituta za patologijo, ambulantnih bolnikov in drugih bolnišnic nismo upoštevali v raziskavi. Za vsak primer pnevmokokne bakteriemije smo izpolnili standardiziran vprašalnik, v katerem smo zabeležili starost, spol, bolniški oddelek, datum bakteriemije, dolžino bolnišničnega zdravljenja, potrebo po sprejemu v intenzivno enoto, klinični sindrom, vitalne znake, izvid rentgenskega slikanja prsnih organov, občutljivost pnevmokokov, antibiotično zdravljenje in izhod bolezni. Poleg tega smo zabeležili morebitne dejavnike tveganja za pnevmokokno okužbo, izvid testiranja na HIV in morebitno cepljenje proti pnevmoknim okužbam.
Deskriptorji		STREPTOCOCCUS PNEUMONIAE BACTEREMIA PNEUMOCOCCAL INFECTIONS HOSPITALIZATION ADULT TREATMENT OUTCOME COHORT STUDIES INCIDENCE SWITZERLAND RISK FACTORS SMOKING HIV INFECTIONS CORONARY DISEASE NEUTROPENIA