Outcomes associated with vancomycin-resistant enterococci: A meta-analysis
Outcomes associated with vancomycin-resistant enterococci: A meta-analysis
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DOI：
10.1086/502271
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发表时间：
2003-09-01
影响因子：
4.5
通讯作者：
Farr, BM
中科院分区：
文献类型：
--
作者：
Salgado, CD;Farr, BM
背景：由于耐万古霉素肠球菌菌血症(VREB)患者的病情严重程度通常较高，目前尚不清楚VREB是否比万古霉素敏感的肠球菌菌血症更严重。方法：从Medline(1986年1月至2002年4月)确定的比较VREB和VSEB的研究和会议摘要中汇集有关发病率、病死率和成本的数据。用列联表卡方检验研究间的异质性。对控制其他预测因素的多变量分析(MVA)进行评估。结果：13项研究比较了VREB和VSEB的病死率。VREB病例病死率显著高于对照组(48.9%对19%；RR，2.57；CI95，2.27至2.91；归因死亡率=30%)。5项研究比较了VREB和VSEB，当菌血症是直接死亡原因时；VREB病例病死率显著更高(39.1%对21.8%；RR，1.79；CI95，1.28至2.5；归因死亡率=17%)。4个MVA发现病死率显著增加(OR，2.10到4.0)，3个有增加趋势(OR，1.74到3.34，宽可信区间)，3个低统计能力的MVA没有发现差异。VREB复发率为16.9%，VSEB复发率为3.7%(P<；0.0001)。有三项研究报告了VREB患者的LOS和/或费用显著增加。结论：大多数研究的样本量不足，或对其他不良结果的预测因素调整不足，或两者兼而有之，但现有数据表明，VREB与更高的复发率、死亡率和额外费用有关，其中包括对疾病严重程度进行调整的多项研究。
BACKGROUND: Because patients with vancomycin-resistant Enterococcus bacteremia (VREB) usually have a higher severity of illness, it has been unclear whether VREB is worse than vancomycin-susceptible Enterococcus bacteremia. (VSEB).METHODS: Data on morbidity and case fatality rates and costs were pooled from studies comparing VREB and VSEB, identified by Medline (January 1986 to April 2002) and meeting abstracts. Heterogeneity across studies was assessed with contingency table chi-square. Multivariate analyses (MVAs) controlling for other predictors were evaluated.RESULTS: Thirteen studies compared case-fatality rates of VREB and VSEB. VREB case fatality was significantly higher (48.9% vs 19%; RR, 2.57; CI95, 2.27 to 2.91; attributable mortality = 30%). Five studies compared VREB with VSEB when bacteremia was the direct cause of death; VREB case fatality was significantly higher (39.1% vs 21.8%; RR, 1.79; CI95, 1.28 to 2.5; attributable mortality = 17%). Four MVAs found significant increases in case-fatality rates (OR, 2.10 to 4.0), 3 showed trends toward increase (OR, 1.74 to 3.34 with wide confidence intervals), and 3 with low statistical power found no difference. VREB recurred in 16.9% versus 3.7% with VSEB (P < .0001). Three studies reported significant increases in LOS, costs, or both with VREB.CONCLUSION: Most studies have had inadequate sample size, inadequate adjustment for other predictors of adverse outcomes, or both, but available data suggest that VREB is associated with higher recurrence, mortality, and excess costs than VSEB including multiple studies adjusting for severity of illness.