Prevalence of Carbapenem-Resistant Gram-Negative Infections in the United States Predominated by Acinetobacter baumannii and Pseudomonas aeruginosa.
Prevalence of Carbapenem-Resistant Gram-Negative Infections in the United States Predominated by Acinetobacter baumannii and Pseudomonas aeruginosa.
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DOI：
10.1093/ofid/ofx176
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发表时间：
2017
影响因子：
4.2
通讯作者：
Nagata TD
中科院分区：
文献类型：
--
作者：
Cai B;Echols R;Magee G;Arjona Ferreira JC;Morgan G;Ariyasu M;Sawada T;Nagata TD
碳青霉烯耐药（CR）革兰氏阴性病原体被认为是一个主要的健康问题。本研究调查了美国4种CR革兰氏阴性菌（鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和大肠杆菌）感染的流行情况，并评估了它们对住院时间和死亡率的影响。由4种革兰氏阴性病原体中的任何一种引起的实验室确诊感染的住院患者从Premier Healthcare数据库中确定。按病原体和感染部位（血液、呼吸道、尿液或其他）计算全美国和人口普查地区的CR比例。使用逻辑回归得出住院死亡率的粗比值比和调整后的比值比。2009 - 2013年4种革兰氏阴性病原菌感染292742例中，CR感染13 262例（4.5%），其中鲍曼不溶菌（22%）或铜绿假单胞菌（60.3%）感染占82.3%，肺炎克雷伯菌和大肠杆菌感染占17.7%。在所有病原体感染部位的队列中，CR患者比碳青霉烯类敏感（CS）患者住院时间更长，除了鲍曼杆菌-呼吸道队列。与CS组相比，CR组大多数病原体感染部位队列的粗全因住院死亡率更高，特别是血液中的鲍曼不饱和杆菌感染（粗优势比[OR]， 3.91； 95%可信区间[CI]， 2.69-5.70）。校正相关协变量后，鲍曼不动杆菌-血液组的差异仍然存在（校正OR为2.46；95% CI为1.43-4.22）。在美国，大多数CR感染和疾病负担是由非发酵菌鲍曼假单胞菌和铜绿假单胞菌引起的。CR感染患者住院时间较长，院内粗死亡率较高。
Carbapenem-resistant (CR) Gram-negative pathogens are recognized as a major health concern. This study examined the prevalence of infections due to 4 CR Gram-negative species (Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Escherichia coli) in the United States and assessed their impact on hospital stays and mortality. Hospitalized patients with laboratory-confirmed infection due to any of the 4 Gram-negative pathogens were identified from the Premier Healthcare Database. Proportions of CR were calculated by pathogen and infection site (blood, respiratory, urinary, or other) for the United States as whole and by census regions. Crude and adjusted odds ratios for in-hospital mortality were produced using logistic regression. From 2009 to 2013, 13 262 (4.5%) of 292 742 infections due to these 4 Gram-negative pathogens were CR. Of these CR infections, 82.3% were caused by A. baumannii (22%) or P. aeruginosa (60.3%), while 17.7% were caused by K. pneumoniae or E. coli. CR patients had longer hospital stays than carbapenem-susceptible (CS) patients in all pathogen-infection site cohorts, except in the A. baumannii-respiratory cohort. The crude all cause in-hospital mortality was greater for most pathogen-infection site cohorts of the CR group compared with the CS group, especially for A. baumannii infection in the blood (crude odds ratio [OR], 3.91; 95% confidence interval [CI], 2.69–5.70). This difference for the A. baumannii-blood cohort remained after adjusting for the relevant covariates (adjusted OR, 2.46; 95% CI, 1.43–4.22). The majority of CR infections and disease burden in the United States was caused by nonfermenters A. baumannii and P. aeruginosa. Patients with CR infections had longer hospital stays and higher crude in-hospital mortality.