Impact of Different Antimicrobial Therapies on Clinical and Fiscal Outcomes of Patients with Bacteremia Due to Vancomycin-Resistant Enterococci
Impact of Different Antimicrobial Therapies on Clinical and Fiscal Outcomes of Patients with Bacteremia Due to Vancomycin-Resistant Enterococci
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DOI：
10.1128/aac.02943-14
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发表时间：
2014-07-01
影响因子：
4.9
通讯作者：
Kaye, Keith S.
中科院分区：
文献类型：
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作者：
Hayakawa, Kayoko;Martin, Emily T.;Kaye, Keith S.
耐万古霉素肠球菌（VRE）是一个日益严重的健康问题，并且对于VRE引起的血液感染的最佳治疗存在不确定性。我们对不同抗菌治疗对VRE所致血流感染患者结局的影响进行了系统的比较评价。2008年1月至2010年10月在底特律医疗中心进行了一项回顾性研究。纳入并审查了因VRE而进行血培养的独特患者。分析了三种主要的治疗类别：达托霉素、利奈唑胺和β-内酰胺类。三个多变量模型进行了每一个结果，匹配的倾向得分预测的可能性，收到的治疗类之一。共纳入225例VRE引起的菌血症病例，其中VR粪肠球菌86例（38.2%），VR屎肠球菌139例（61.8%）。由VR E引起的菌血症。β-内酰胺类药物治疗受试者中粪尿症的发生率高于达托霉素或利奈唑胺治疗受试者。达托霉素的中位剂量为6 mg/kg体重（范围：6 - 12 mg/kg）。在控制倾向评分和由于VR E引起的菌血症后。粪，死亡率的差异是不显着的治疗组。与利奈唑胺相比，达托霉素治疗与每日中位可变直接成本较高相关。这项大型研究显示，三种治疗类别（达托霉素、利奈唑胺和β-内酰胺类）在治疗VRE敏感菌株引起的菌血症方面具有相似的有效性。
Vancomycin-resistant enterococci (VRE) are a growing health problem, and uncertainties exist regarding the optimal therapy for bloodstream infection due to VRE. We conducted systematic comparative evaluations of the impact of different antimicrobial therapies on the outcomes of patients with bloodstream infections due to VRE. A retrospective study from January 2008 to October 2010 was conducted at Detroit Medical Center. Unique patients with blood cultures due to VRE were included and reviewed. Three major therapeutic classes were analyzed: daptomycin, linezolid, and beta-lactams. Three multivariate models were conducted for each outcome, matching for a propensity score predicting the likelihood of receipt of one of the therapeutic classes. A total of 225 cases of bacteremia due to VRE were included, including 86 (38.2%) cases of VR Enterococcus faecalis and 139 (61.8%) of VR Enterococcus faecium. Bacteremia due to VR E. faecalis was more frequent among subjects treated with beta-lactams than among those treated with daptomycin or linezolid. The median dose of daptomycin was 6 mg/kg of body weight (range, 6 to 12 mg/kg). After controlling for propensity score and bacteremia due to VR E. faecalis, differences in mortality were nonsignificant among the treatment groups. Therapy with daptomycin was associated with higher median variable direct cost per day than that for linezolid. This large study revealed the three therapeutic classes (daptomycin, linezolid, and beta-lactams) are similarly efficacious in the treatment of bacteremia due to susceptible strains of VRE.