Risk factors for recurrent melioidosis in northeast Thailand
Risk factors for recurrent melioidosis in northeast Thailand
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DOI：
10.1086/507632
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发表时间：
2006-10-15
影响因子：
11.8
通讯作者：
Peacock, Sharon J.
中科院分区：
文献类型：
--
作者：
Limmathurotsakul, Direk;Chaowagul, Wipada;Peacock, Sharon J.
背景。在首次发病后的第一年，6%的患者会发生类似的类鼻疽复发。最近的一项研究表明，25%的复发患者是再感染，而不是因治疗失败而复发。本研究的目的是重新评估这两组患者，以确定他们的个体危险因素。1986-2004年期间到sappasthiiprasong医院（泰国东北部的Ubon Ratchathani）就诊并经培养证实为类鼻炎的所有成年患者，存活下来接受了口服抗菌药物治疗，直至2005年7月。采用时变Cox比例风险模型，比较经细菌基因分型证实的复发或再感染患者的临床因素和抗菌药物治疗。在889例存活并随访的患者中，86例（9.7%）复发，30例（3.4%）再次感染。复发组和再感染组的急性转归无差异。未发现再感染的危险因素。多因素分析发现，口服抗菌药物治疗的选择和持续时间是复发的最重要决定因素，其次是血培养阳性结果（风险比[HR]， 1.86； 95%可信区间[CI]， 1.18-2.92）和多灶分布（风险比，1.95;95% CI, 1.03-3.67）。接受适当的口服抗生素方案治疗12-16周的患者，复发风险降低90% （HR, 0.10; 95% CI, 0.02-0.44）
Background. Recurrent melioidosis occurs in similar to 6% of patients in the first year following the initial presentation. A recent study revealed that 25% of patients with recurrence had reinfection rather than a relapse resulting from a failure to cure. The aim of this study was to reevaluate these 2 patient groups to define their individual risk factors.Methods. All adult patients who presented to Sappasithiprasong Hospital (Ubon Ratchathani, in northeast Thailand) with culture-confirmed melioidosis during the period 1986-2004 and who survived to receive oral antimicrobial therapy were observed until July 2005. Clinical factors and antimicrobial treatment of patients with recurrent disease due to relapse or reinfection, as confirmed by bacterial genotyping, were compared using a time-varying Cox proportional hazard model.Results. Of 889 patients who survived and underwent follow-up, 86 patients (9.7%) presented with relapse, and 30 patients (3.4%) became reinfected. There was no difference in acute outcome between the relapse and reinfection groups. No risk factors for reinfection were identified. Multivariate analyses identified choice and duration of oral antimicrobial therapy as the most important determinants of relapse, followed by positive blood culture result ( hazard ratio [HR], 1.86; 95% confidence interval [CI], 1.18-2.92) and multifocal distribution ( HR, 1.95; 95% CI, 1.03-3.67). Patients treated with an appropriate oral antibiotic regimen for 12-16 weeks had a 90% decreased risk of relapse ( HR, 0.10; 95% CI, 0.02-0.44), compared with patients who were treated for