Stratification of the Impact of Inappropriate Empirical Antimicrobial Therapy for Gram-Negative Bloodstream Infections by Predicted Prognosis
Stratification of the Impact of Inappropriate Empirical Antimicrobial Therapy for Gram-Negative Bloodstream Infections by Predicted Prognosis
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DOI：
10.1128/aac.03935-14
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发表时间：
2015-01-01
影响因子：
4.9
通讯作者：
Al-Hasan, Majdi N.
中科院分区：
文献类型：
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作者：
Cain, Sarah E.;Kohn, Joseph;Al-Hasan, Majdi N.
血流感染死亡风险评分(BSIMRS)预测革兰氏阴性血流感染(BSI)患者的预后具有高度的区分性。这项回顾性队列研究考察了2011年1月1日至2012年12月31日在美国南卡罗来纳州哥伦比亚市棕榈树健康医院住院的革兰氏阴性BSI成年患者中，不适当的抗菌治疗对死亡率的影响，在使用BSIMRS对首次出现时预测的预后进行分层后。使用多变量COX回归模型来确定28天死亡率的独立危险因素，包括总体和每个预定义的BSIMRS类别(=10)。根据死亡率的预测Logistic回归模型计算相对风险降低(RRR)、绝对风险降低(ARR)和需要治疗的数量(NNT)。总体而言，390名首次出现革兰氏阴性BSI的独特患者被确定。中位年龄为66岁，其中229人(59%)为女性。BSIMRS为5~9(调整后的危险比为3.55；95%可信区间为1.22~8.31；P=0.02)和BSIMRS=10(AHR为4.99；95%CI为1.09~22.87；P=0.04)与死亡率显著相关，而BSIMRS=10的患者与预后无关。预后良好(BSIMRS)的患者存活率差异尚不清楚
The bloodstream infection mortality risk score (BSIMRS) predicts the outcome of patients with Gram-negative bloodstream infections (BSI) with high discrimination. This retrospective cohort study examined the impact of inappropriate antimicrobial therapy on mortality in adult patients with Gram-negative BSI admitted to Palmetto Health Hospitals in Columbia, SC, USA, from 1 January 2011 to 31 December 2012 after stratification by predicted prognosis at initial presentation using BSIMRS. A multivariate Cox regression model was used to identify independent risk factors for 28-day mortality overall and within each predefined BSIMRS category (= 10). Relative risk reduction (RRR), absolute risk reduction (ARR), and number needed to treat (NNT) were calculated from a predictive logistic regression model of mortality. Overall, 390 unique patients with first episodes of Gram-negative BSI were identified. The median age was 66 years, and 229 (59%) were women. There was significant association between inappropriate antimicrobial therapy and mortality in patients with BSIMRS of 5 to 9 (adjusted hazard ratio [aHR], 3.55; 95% confidence intervals [CI], 1.22 to 8.31; P = 0.02) and BSIMRS of >= 10 (aHR, 4.99; 95% CI, 1.09 to 22.87; P = 0.04) but not in those with BSIMRS of = 10) predicted prognosis. Survival difference remains unclear among those with good predicted prognosis (BSIMRS of