Risk factors for development of aminoglycoside resistance among gram-negative rods.
Risk factors for development of aminoglycoside resistance among gram-negative rods.
复制标题
革兰氏阴性杆菌中出现氨基糖苷类耐药性的危险因素。
DOI：
10.1093/ajhp/zxz201
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
McKinnell,JamesA
中科院分区：
文献类型：
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作者：
Richter,StefanE;Miller,Loren;Needleman,Jack;Uslan,DanielZ;Bell,Douglas;Watson,Karol;Humphries,Romney;McKinnell,JamesA
PurposeDevelopment的评分系统，以预测氨基糖苷类抗生素耐药的风险，并指导therapyaddress.MethodsInfections由于氨基糖苷类抗生素耐药革兰氏阴性杆菌（AR-GNRs）越来越常见，并与不良后果;选择有效的初始抗生素治疗是必要的，以减少不良后果，缩短住院时间。为了确定AR-GNR从培养物中恢复的风险因素，回顾性分析了2011-2016年期间在一家主要学术医院系统的2家机构住院的患者中GNR感染病例。分别分析庆大霉素和妥布霉素耐药（GTR-GNR）和阿米卡星耐药（AmR-GNR）模式。对来自12,516名患者的26,154株GNR分离株进行了分析，其中6,699株为GTR，2,467株为AmR.ResultsIn多变量分析，GTR-GNR的风险因素为体重减轻、从另一家医疗机构或长期护理机构入院、血红蛋白水平<11 g/dL、在前30天内接受任何碳青霉烯类药物、在过去30天内接受任何氟喹诺酮类药物治疗（C统计量，0.63）。AmR-GNR的风险因素包括囊性纤维化的诊断、男性、从另一家医疗机构或长期护理机构入院、在索引住院期间培养前任何时间点的通气、在前30天内接受任何碳青霉烯类药物以及在前30天内接受任何抗MRSA药物（C统计量，0.74）。多项和有序模型表明，风险因素的2个电阻patterns differents.ConclusionA评分系统来自发达的风险预测模型可以应用于供应商，以指导经验性的抗菌治疗GNR感染。
PurposeDevelopment of scoring systems to predict the risk of aminoglycoside resistance and to guide therapy is described.MethodsInfections due to aminoglycoside-resistant gram-negative rods (AR-GNRs) are increasingly common and associated with adverse outcomes; selection of effective initial antibiotic therapy is necessary to reduce adverse consequences and shorten length of stay. To determine risk factors for AR-GNR recovery from culture, cases of GNR infection among patients admitted to 2 institutions in a major academic hospital system during the period 2011–2016 were retrospectively analyzed. Gentamicin and tobramycin resistance (GTR-GNR) and amikacin resistance (AmR-GNR) patterns were analyzed separately. A total of 26,154 GNR isolates from 12,516 patients were analyzed, 6,699 of which were GTR, and 2,467 of which were AmR.ResultsIn multivariate analysis, risk factors for GTR-GNR were presence of weight loss, admission from another medical or long-term care facility, a hemoglobin level of <11 g/dL, receipt of any carbapenem in the prior 30 days, and receipt of any fluoroquinolone in the prior 30 days (C statistic, 0.63). Risk factors for AmR-GNR were diagnosis of cystic fibrosis, male gender, admission from another medical or long-term care facility, ventilation at any point prior to culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-MRSA agent in the prior 30 days (C statistic, 0.74). Multinomial and ordinal models demonstrated that the risk factors for the 2 resistance patterns differed significantly.ConclusionA scoring system derived from the developed risk prediction models can be applied by providers to guide empirical antimicrobial therapy for treatment of GNR infections.