Additional risk factors for infection by multidrug-resistant pathogens in healthcare-associated infection: a large cohort study.
Additional risk factors for infection by multidrug-resistant pathogens in healthcare-associated infection: a large cohort study.
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DOI：
10.1186/1471-2334-12-375
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发表时间：
2012-12-26
影响因子：
3.7
通讯作者：
Sarmento AE
中科院分区：
文献类型：
--
作者：
Cardoso T;Ribeiro O;Aragão IC;Costa-Pereira A;Sarmento AE
关于医疗保健相关感染（HCAI）风险因素的定义缺乏共识。本研究的目的是确定HCAI的其他风险因素，这些风险因素不包括在当前的HCAI定义中，与社区所有住院感染患者的多药耐药（MDR）病原体感染相关。这项为期1年的前瞻性队列研究包括所有在大型三级护理大学医院住院的感染患者。未纳入HCAI定义的风险因素，与MDR病原体感染独立相关，即MDR革兰氏阴性（MDR-GN）和ESKAPE微生物（耐万古霉素屎肠球菌、耐甲氧西林金黄色葡萄球菌、产超广谱β-内酰胺酶大肠埃希菌和克雷伯菌属、碳青霉烯水解性肺炎克雷伯菌和MDR鲍曼不动杆菌、铜绿假单胞菌、肠杆菌属），在社区收治的患者（社区获得性或HCAI）中通过logistic回归确定。感染者1035人，718人来自社区。其中，439例（61%）有微生物学记录; 123例为MDR（28%）。在MDR中：104例（85%）有MDR-GN，41例（33%）有ESKAPE感染。与MDR和MDR-GN感染相关的独立风险因素为：年龄（调整后的比值比（OR）分别为1.7和1.5，p = 0.001和p = 0.009）和前一年的住院时间（之前4至12个月）（调整后的OR分别为2.0和1.7，p = 0.008和p = 0.048）。ESKAPE组的病原体感染与既往抗生素治疗独立相关（调整OR = 7.2，p < 0.001），Karnofsky指数<70（调整OR = 3.7，p = 0.003）。ESKAPE组中有MDR、MDR-GN和病原体感染的患者的抗生素治疗不充分率显著高于无感染的患者（分别为46% vs 7%，44% vs 10%，61% vs 15%，p < 0.001）。这项研究表明，在目前对MDR病原体感染的HCAI定义中纳入额外的风险因素，即年龄>60岁，Karnofsky指数<70，前一年住院治疗和既往抗生素治疗，可能有利于早期诊断，这可能会降低这些患者中抗生素治疗不足的发生率。
There is a lack of consensus regarding the definition of risk factors for healthcare-associated infection (HCAI). The purpose of this study was to identify additional risk factors for HCAI, which are not included in the current definition of HCAI, associated with infection by multidrug-resistant (MDR) pathogens, in all hospitalized infected patients from the community. This 1-year prospective cohort study included all patients with infection admitted to a large, tertiary care, university hospital. Risk factors not included in the HCAI definition, and independently associated with MDR pathogen infection, namely MDR Gram-negative (MDR-GN) and ESKAPE microorganisms (vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species, carbapenem-hydrolyzing Klebsiella pneumonia and MDR Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species), were identified by logistic regression among patients admitted from the community (either with community-acquired or HCAI). There were 1035 patients with infection, 718 from the community. Of these, 439 (61%) had microbiologic documentation; 123 were MDR (28%). Among MDR: 104 (85%) had MDR-GN and 41 (33%) had an ESKAPE infection. Independent risk factors associated with MDR and MDR-GN infection were: age (adjusted odds ratio (OR) = 1.7 and 1.5, p = 0.001 and p = 0.009, respectively), and hospitalization in the previous year (between 4 and 12 months previously) (adjusted OR = 2.0 and 1,7, p = 0.008 and p = 0.048, respectively). Infection by pathogens from the ESKAPE group was independently associated with previous antibiotic therapy (adjusted OR = 7.2, p < 0.001) and a Karnofsky index <70 (adjusted OR = 3.7, p = 0.003). Patients with infection by MDR, MDR-GN and pathogens from the ESKAPE group had significantly higher rates of inadequate antibiotic therapy than those without (46% vs 7%, 44% vs 10%, 61% vs 15%, respectively, p < 0.001). This study suggests that the inclusion of additional risk factors in the current definition of HCAI for MDR pathogen infection, namely age >60 years, Karnofsky index <70, hospitalization in the previous year, and previous antibiotic therapy, may be clinically beneficial for early diagnosis, which may decrease the rate of inadequate antibiotic therapy among these patients.
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影响因子：
5.2
作者：
Cheong, Hae Suk;Kang, Cheol-In;Peck, Kyong Ran
通讯作者：
Peck, Kyong Ran
影响因子：
11.8
作者：
Boucher, Helen W.;Talbot, George H.;Bartlett, John
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Bartlett, John
影响因子：
120.7
作者：
LEGALL, JR;LEMESHOW, S;SAULNIER, F
通讯作者：
SAULNIER, F
影响因子：
8.8
作者：
Shorr, Andrew F.;Tabak, Ying P.;Kollef, Marin H.
通讯作者：
Kollef, Marin H.
影响因子：
3.6
作者：
Wright, SW;Wrenn, KD;Haas, DW
通讯作者：
Haas, DW