Infectious Diseases Consultation Lowers Mortality From Staphylococcus aureus Bacteremia
Infectious Diseases Consultation Lowers Mortality From Staphylococcus aureus Bacteremia
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DOI：
10.1097/md.0b013e3181b8fccb
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发表时间：
2009-09-01
期刊：
影响因子：
1.6
通讯作者：
Kirkland, Kathryn
中科院分区：
文献类型：
--
作者：
Lahey, Timothy;Shah, Ruta;Kirkland, Kathryn
金黄色葡萄球菌菌血症(SAB)是住院患者中一种致命性且日益常见的感染。通过一项回顾性队列研究，我们评估了240名住院患者的传染病会诊(IDC)对SAB的临床管理和住院死亡率的影响。接受IDC的患者比没有接受IDC的患者年龄更大(57.9岁比51.7岁；p=0.05)，并且更有可能发生与医疗保健相关的感染(63%比45%；p<；0.01)。在接受IDC治疗的患者中，SAB严重并发症的发生率较高，如中枢神经系统受累(5%比0%，p=0.01)、心内膜炎(20%比2%；p<；0.01)或骨髓炎(15.6%比3.4%；p<；0.01)。接受IDC治疗的患者有更密切的血培养随访和更好的抗生素选择，并且更有可能清除脓液或假体材料。接受IDC治疗的患者SAB的住院死亡率低于未接受IDC治疗的患者(13.9%比23.7%；p=0.05)。在多变量生存分析中，IDC与SAB期间住院死亡率显著降低相关(危险0.46；p=0.03)。这一死亡率收益主要发生在耐甲氧西林的SAB患者(危险0.3；p<；0.01)和不需要ICU入院的患者(危险0.15；p=0.01)。总之，IDC与葡萄球菌菌血症患者死亡率的降低有关。
Staphylococcus aureus bacteremia (SAB) is a lethal and increasingly common infection ill hospitalized patients. We assessed the impact of infectious diseases consultation (IDC) on clinical management and hospital mortality of SAB in 240 hospitalized patients ill a retrospective cohort study. Patients who received IDC were older than those who did not (57.9 vs. 51.7 yr; p = 0.05), and were more likely to have a health care-associated infection (63% vs. 45%; p < 0.01). In patients who received IDC, there was a higher prevalence of severe complications of SAB such as central nervous system involvement (5% vs. 0%, p = 0.01), endocarditis (20% vs. 2%; p < 0.01), or osteomyelitis (15.6% vs. 3.4%; p < 0.01). Patients who received IDC had closer blood culture follow-up and better antibiotic selection, and were more likely to have pus or prosthetic material removed. Hospital mortality from SAB was lower in patients who received IDC than in those who did not (13.9% vs. 23.7%; p = 0.05). In multivariate survival analysis, IDC was associated with substantially lower hazard of hospital mortality during SAB (hazard 0.46; p = 0.03). This mortality benefit accrued predominantly in patients with methicillin-resistant SAB (hazard 0.3; p < 0.01), and in patients who did not require ICU admission (hazard 0.15; p = 0.01). In conclusion, IDC is associated with reduced mortality in patients with staphylococcal bacteremia.