BACKGROUND Community acquired bacteremia (CAB) is a common cause of sepsis in low and middle-income countries (LMICs). However, knowledge about factors associated with outcomes of CAB in LMICs is limited. METHODOLOGY/PRINCIPAL FINDINGS A prospective observational study (Ubon-sepsis) of adults admitted to a referral hospital with community-acquired infection in Northeastern Thailand was conducted between March 1, 2013 and February 1, 2017. In the present analysis, patients with a blood culture collected within 24 hours of admission that was positive for one of the three most common pathogens were studied. Clinical features, management, and outcomes of patients with each cause of CAB were compared. Of 3,806 patients presenting with community-acquired sepsis, 155, 131 and 37 patients had a blood culture positive for Escherichia coli, Burkholderia pseudomallei and Staphylococcus aureus, respectively. Of these 323 CAB patients, 284 (89%) were transferred from other hospitals. 28-day mortality was highest in patients with B. pseudomallei bactaeremia (66%), followed by those with S. aureus bacteraemia (43%) and E. coli (19%) bacteraemia. In the multivariable Cox proportional hazards model adjusted for age, sex, transfer from another hospital, empirical antibiotics prior to or during the transfer, and presence of organ dysfunction on admission, B. pseudomallei (aHR 3.78; 95%CI 2.31-6.21) and S. aureus (aHR 2.72; 95%CI 1.40-5.28) bacteraemias were associated with higher mortality compared to E. coli bacteraemia. Receiving empirical antibiotics recommended for CAB caused by the etiologic organism prior to or during transfer was associated with survival (aHR 0.58; 95%CI 0.38-0.88). CONCLUSIONS/SIGNIFICANCE Mortality of patients with CAB caused by B. pseudomallei was higher than those caused by S. aureus and E. coli, even after adjusting for presence of organ dysfunction on admission and effectiveness of empirical antibiotics received. Improving algorithms or rapid diagnostic tests to guide early empirical antibiotic may be key to improving CAB outcomes in LMICs.

中文翻译：

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由大肠杆菌、假鼻疽伯克霍尔德菌和金黄色葡萄球菌引起的社区获得性菌血症患者的比较临床特征和结果：一项前瞻性观察研究（乌汶败血症）。

背景社区获得性菌血症 (CAB) 是中低收入国家 (LMIC) 败血症的常见原因。然而，关于与 LMIC 中 CAB 结果相关的因素的知识是有限的。方法学/主要发现 2013 年 3 月 1 日至 2017 年 2 月 1 日期间，对泰国东北部因社区获得性感染转诊医院收治的成年人进行了一项前瞻性观察研究（乌汶脓毒症）。研究了入院 24 小时内收集的对三种最常见病原体之一呈阳性的培养物。比较了各种原因导致的 CAB 患者的临床特征、管理和结果。在出现社区获得性败血症的 3,806 名患者中，155、131 和 37 名患者的血培养大肠杆菌呈阳性，分别为鼻疽伯克霍尔德菌和金黄色葡萄球菌。在这 323 名 CAB 患者中，284 名（89%）是从其他医院转来的。假鼻疽菌血症患者的 28 天死亡率最高（66%），其次是金黄色葡萄球菌菌血症（43%）和大肠杆菌（19%）菌血症患者。在多变量 Cox 比例风险模型中，根据年龄、性别、从另一家医院转移、转移前或转移过程中经验性抗生素以及入院时是否存在器官功能障碍进行了调整，假鼻疽芽孢杆菌 (aHR 3.78; 95%CI 2.31-6.21) 和与大肠杆菌菌血症相比，金黄色葡萄球菌 (aHR 2.72；95% CI 1.40-5.28) 菌血症与更高的死亡率相关。在转移前或转移过程中接受由病原体引起的 CAB 推荐的经验性抗生素与生存相关（aHR 0.58；95% CI 0.38-0.88）。结论/意义 即使在对入院时器官功能障碍的存在和经验性抗生素的有效性进行调整后，由假鼻疽芽孢杆菌引起的 CAB 患者的死亡率仍高于由金黄色葡萄球菌和大肠杆菌引起的患者。改进算法或快速诊断测试以指导早期经验性抗生素可能是改善 LMIC 中 CAB 结果的关键。