Retrospective Observational Study from a Chinese Network of the Impact of Combination Therapy versus Monotherapy on Mortality from Carbapenem-Resistant Enterobacteriaceae Bacteremia
Retrospective Observational Study from a Chinese Network of the Impact of Combination Therapy versus Monotherapy on Mortality from Carbapenem-Resistant Enterobacteriaceae Bacteremia
复制标题
DOI：
10.1128/aac.01511-18
复制
发表时间：
2019-01-01
影响因子：
4.9
通讯作者：
Wang, Hui
中科院分区：
文献类型：
--
作者：
Wang, Xiaojuan;Wang, Qi;Wang, Hui
回顾性收集了2013年至2017年来自中国19个省份36家三级医院的164例碳青霉烯类耐药肠杆菌科（CRE）血流感染病例的数据，通过单变量和多变量分析评价结局和死亡风险因素。肺炎克雷伯菌为最常见的感染菌（69.5%，114/164）。总的住院死亡率和14天死亡率分别为32.9%（54/164）和31.1%（42/135）。多变量分析显示感染性休克（校正比值比[aOR]，6.339; 95%置信区间[CI]，1.586至25.332; P = 0.009），Pitt菌血症评分（aOR，1.300; 95%CI，1.009 - 1.676; P = 0.042）和Charlson合并症指数（aOR，1.392; 95%CI，1.104 - 1.755; P = 0.005）与死亡率的风险效应独立相关。联合治疗，特别是基于替加替尼的联合治疗，导致院内死亡率和CRE感染清除失败率相对较低。生存分析显示，适当的治疗与14天死亡率低于不适当的治疗（包括非活性治疗; P = 0.022），联合治疗优于单药治疗（上级）（P = 0.036），与不含碳青霉烯酶或KPC-2生产者的菌株相比，金属β-内酰胺酶生产者与14天死亡率较低相关（P = 0.009），美罗培南MIC>8 mg/L的菌株14天死亡率高于MIC为8 mg/L的菌株，产碳青霉烯酶的菌株与临床结局相关。早期检测碳青霉烯酶类型并在96 h内开始适当的联合治疗可能有助于改善生存率。
Data for a total of 164 bloodstream infection cases due to carbapenem-resistant Enterobacteriaceae (CRE) from 2013 to 2017 were retrospectively collected from 36 tertiary hospitals in 19 provinces in China to evaluate the outcomes and risk factors for mortality by univariable and multivariable analysis. The most frequent infecting species was Klebsiella pneumoniae (69.5%, 114/164). The overall in-hospital and 14-day mortality rates were 32.9% (54/164) and 31.1% (42/135), respectively. Multivariable analysis revealed that septic shock (adjusted odds ratio [aOR], 6.339; 95% confidence interval [CI], 1.586 to 25.332; P = 0.009), the Pitt bacteremia score (aOR, 1.300; 95% CI, 1.009 to 1.676; P = 0.042), and the Charlson comorbidity index (aOR, 1.392; 95% CI, 1.104 to 1.755; P = 0.005) were independently associated with a hazard effect on mortality. Combination therapy, especially tigecycline-based combination therapy, resulted in relatively low rates of in-hospital mortality and failure in clearance of CRE infection. Survival analysis revealed that appropriate therapy was associated with a lower 14-day mortality rate than inappropriate therapy (including nonactive therapy; P = 0.022), that combination therapy was superior to monotherapy (P = 0.036), that metallo-beta-lactamase producers were associated with a lower 14-day mortality than strains without carbapenemases or KPC-2 producers (P = 0.009), and that strains with MICs of >8 mg/liter for meropenem were associated with a higher 14-day mortality rate than those with MICs of 8 mg/liter, and carbapenemase-producing types were associated with the clinical outcome. Early detection of the carbapenemase type and initiation of appropriate combination therapy within 96 h might be helpful for improving survival.