Enterococcal bacteraemia: factors influencing mortality, length of stay and costs of hospitalization
Enterococcal bacteraemia: factors influencing mortality, length of stay and costs of hospitalization
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DOI：
10.1111/1469-0691.12132
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发表时间：
2013-04-01
影响因子：
14.2
通讯作者：
Kong, D. C. M.
中科院分区：
文献类型：
--
作者：
Cheah, A. L. Y.;Spelman, T.;Kong, D. C. M.
肠球菌是医院内菌血症的主要原因。万古霉素耐药和抗生素治疗对肠球菌菌血症预后的影响尚不清楚。影响住院时间（LOS）和管理肠球菌菌血症患者的费用的因素也是未知的。本研究旨在确定与肠球菌菌血症患者死亡率、LOS和住院费用相关的因素，以及万古霉素耐药和抗生素治疗对这些结局的影响。对来自澳大利亚两家医院的116例万古霉素耐药肠球菌（VRE）患者的数据进行了临床和经济结局的审查，这些患者与万古霉素敏感肠球菌（VSE）患者1：1匹配。单变量和多变量logistic和分位数回归分析确定了与死亡率、LOS和费用相关的因素。重症监护室入院（OR，8.57; 95%CI，3.99 ± 18.38）、较高的合并症负担（OR，4.55; 95%CI，1.83 ± 11.33）和较长的适当抗生素使用时间（OR，1.02; 95%CI，1.01 ± 1.03）与肠球菌菌血症的死亡率显著相关。校正混杂因素后，万古霉素B耐药增加了LOS（4.89天; 95%CI，0.5611.52）和住院费用（Au $28872; 95%CI，73470667）。值得注意的是，利奈唑胺确定性治疗与vanB VRE菌血症患者的死亡率较低（OR，0.13; 95% CI，0.030.58）相关。在VSE菌血症患者中，使用适当抗生素的时间独立影响死亡率、LOS和住院费用，基础共病与死亡率相关。研究结果强调了预防VRE菌血症的重要性以及在肠球菌菌血症管理中使用适当抗生素的时间的重要性。
Enterococci are a major cause of nosocomial bacteraemia. The impacts of vanB vancomycin resistance and antibiotic therapy on outcomes in enterococcal bacteraemia are unclear. Factors that affect length of stay (LOS) and costs of managing patients with enterococcal bacteraemia are also unknown. This study aimed to identify factors associated with mortality, LOS and hospitalization costs in patients with enterococcal bacteraemia and the impact of vancomycin resistance and antibiotic therapy on these outcomes. Data from 116 patients with vancomycin-resistant Enterococci (VRE), matched 1:1 with patients with vancomycin-susceptible Enterococcus (VSE), from two Australian hospitals were reviewed for clinical and economic outcomes. Univariable and multivariable logistic and quantile regression analyses identified factors associated with mortality, LOS and costs. Intensive care unit admission (OR, 8.57; 95% CI, 3.9918.38), a higher burden of co-morbidities (OR, 4.55; 95% CI, 1.8311.33) and longer time to appropriate antibiotics (OR, 1.02; 95% CI, 1.011.03) were significantly associated with mortality in enterococcal bacteraemia. VanB vancomycin resistance increased LOS (4.89days; 95% CI, 0.5611.52) and hospitalization costs (AU$ 28872; 95% CI, 73470667), after adjustment for confounders. Notably, linezolid definitive therapy was associated with lower mortality (OR, 0.13; 95% CI, 0.030.58) in vanB VRE bacteraemia patients. In patients with VSE bacteraemia, time to appropriate antibiotics independently influenced mortality, LOS and hospitalization costs, and underlying co-morbidities were associated with mortality. The study findings highlight the importance of preventing VRE bacteraemia and the significance of time to appropriate antibiotics in the management of enterococcal bacteraemia.