Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia
Impact of imipenem resistance on mortality in patients with Acinetobacter bacteraemia
复制标题
DOI：
10.1093/jac/dkl499
复制
发表时间：
2007-03-01
影响因子：
5.2
通讯作者：
Lee, Nam Yong
中科院分区：
文献类型：
--
作者：
Kwon, Ki Tae;Oh, Won Sup;Lee, Nam Yong
目的：探讨亚胺培南耐药对不动杆菌菌血症患者死亡率的影响。方法：2000年1月至2005年6月在韩国三所三级甲等医院进行回顾性、配对（1：1）、风险调整（年龄、Pitt菌血症评分）队列研究。结果：40例亚胺培南不敏感不动杆菌菌血症患者包括 40 名匹配的亚胺培南敏感不动杆菌菌血症受试者（INAB 组）和 40 名匹配受试者（1:1 比例）（ISAB 组）。两组都具有与疾病严重程度相关的相似临床特征。 INAB 组 (57.5%) 的 30 天死亡率高于 ISAB 组 (27.5%) (P = 0.007)。 INAB 组的抗菌治疗不一致率 (65.0%) 高于 ISAB 组 (20.0%) (P < 0.001)。不一致抗菌治疗患者的30天死亡率（67.6%）高于一致抗菌治疗患者（23.9%）（P < 0.001）。多变量分析显示，年龄、Pitt菌血症评分、免疫抑制状态和不一致的抗菌治疗是不动杆菌菌血症患者30天死亡率的独立危险因素（P < 0.05）。当在多变量分析中排除不一致的抗菌治疗时，亚胺培南耐药与30天死亡率相关（P = 0.005）。结论：亚胺培南耐药对不动杆菌菌血症患者的死亡率有显着影响，这主要归因于不一致抗菌治疗的发生率较高。
Objectives: To investigate the impact of imipenem resistance on the mortality rate among patients with Acinetobacter bacteraemia.Methods: A retrospective, pairwise-matched (1:1), risk-adjusted (age, Pitt bacteraemia score) cohort study was performed at three tertiary care hospitals in Korea from January 2000 to June 2005.Results: Forty patients with imipenem non-susceptible Acinetobacter bacteraemia (INAB group) and 40 matched subjects (1:1 ratio) with imipenem-susceptible Acinetobacter bacteraemia (ISAB group) were included. Both groups had similar clinical features related to the severity of illness. The 30 day mortality rate was higher in the INAB group (57.5%) than the ISAB group (27.5%) (P = 0.007). The rate of discordant antimicrobial therapy was higher in the INAB group (65.0%) than the ISAB group (20.0%) (P < 0.001). The 30 day mortality rate was higher in the patients with discordant antimicrobial therapy (67.6%) than concordant antimicrobial therapy (23.9%) (P < 0.001). Multivariate analysis showed that age, the Pitt bacteraemia score, immunosuppressive status, and discordant antimicrobial therapy were independent risk factors for 30 day mortality among patients with Acinetobacter bacteraemia (P < 0.05). When discordant antimicrobial therapy was excluded in the multivariate analysis, the imipenem resistance was associated with 30 day mortality (P = 0.005).Conclusions: Imipenem resistance has a significant impact on the mortality rate among patients with Acinetobacter bacteraemia, and this is mainly attributable to the higher rate of discordant antimicrobial therapy.