Is Polymicrobial Bacteremia an Independent Risk Factor for Mortality in Acinetobacter baumannii Bacteremia?
Is Polymicrobial Bacteremia an Independent Risk Factor for Mortality in Acinetobacter baumannii Bacteremia?
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DOI：
10.3390/jcm9010153
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发表时间：
2020-01-01
影响因子：
3.9
通讯作者：
Lee, Yi-Tzu
中科院分区：
文献类型：
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作者：
Wang, Yung-Chih;Ku, Wen-Wei;Lee, Yi-Tzu
这项回顾性观察性研究评估了单微生物和多微生物鲍曼不动杆菌血症之间的差异，并确定了可能导致14天死亡率的独立危险因素。2008年8月至2015年7月，台湾北部一家三级医疗中心收治了379例鲍曼不整杆菌血症患者，纳入数据分析。其中多微生物菌血症89例（23.5%），单微生物菌血症290例（76.5%）。单微生物和多微生物鲍曼杆菌血症患者14天死亡率无显著差异（26.9% vs 29.2%, p = 0.77）。控制混杂因素的Logistic回归表明，多微生物菌血症不是死亡率的独立预测因子，而适当的抗菌治疗与降低死亡率独立相关。多微生物菌血症患者的14天死亡率较高，同时从血液中分离出大肠杆菌、铜绿假单胞菌和肠杆菌。与单菌耐多药鲍曼杆菌（MDRAb）菌血症患者相比，MDRAb合并革兰氏阴性杆菌菌血症患者预后更差。与单微生物鲍曼不动杆菌血症相比，多微生物鲍曼不动杆菌血症与14天死亡率无关，尽管在同时分离某些革兰氏阴性菌时观察到更多的死亡。适当的抗菌药物治疗仍然是鲍曼不动杆菌血症患者重要的救命措施。
This retrospective observational study assessed the differences between monomicrobial and polymicrobial A. baumannii bacteremia and identified possible independent risk factors for 14-day mortality. There were 379 patients with A. baumannii bacteremia admitted to a tertiary care center in northern Taiwan between August 2008 and July 2015 enrolled for data analysis. Among them, 89 patients (23.5%) had polymicrobial bacteremia and 290 patients (76.5%) had monomicrobial bacteremia. No significant difference in 14-day mortality was observed between patients with monomicrobial and polymicrobial A. baumannii bacteremia (26.9% vs. 29.2%, p = 0.77). Logistic regression controlled for confounders demonstrated that polymicrobial bacteremia was not an independent predictor of mortality, whereas appropriate antimicrobial therapy was independently associated with reduced mortality. Higher 14-day mortality rates were observed in the polymicrobial bacteremic patients with concomitant isolation of Escherichia coli, Pseudomonas aeruginosa, and Enterobacter spp. from the bloodstream. Compared with patients with monomicrobial multidrug-resistant A. baumannii (MDRAb) bacteremia, those with MDRAb concomitant with Gram-negative bacilli bacteremia had a worse outcome. Polymicrobial A. baumannii bacteremia was not associated with a higher 14-day mortality rate than that of monomicrobial A. baumannii bacteremia, although more deaths were observed when certain Gram-negative bacteria were concomitantly isolated. Appropriate antimicrobial therapy remains an important life-saving measure for A. baumannii bacteremic patients.