Risk factors and outcomes of carbapenem-nonsusceptible Escherichia coli bacteremia: A matched case-control study
Risk factors and outcomes of carbapenem-nonsusceptible Escherichia coli bacteremia: A matched case-control study
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DOI：
10.1016/j.jmii.2010.06.001
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发表时间：
2011-04-01
影响因子：
7.4
通讯作者：
Lee, Ming-Hsun
中科院分区：
文献类型：
--
作者：
Chang, Hong-Jyun;Hsu, Po-Chang;Lee, Ming-Hsun
背景：耐碳青霉烯类肠杆菌科细菌感染已成为世界范围内的新问题。本研究的主要目的是了解碳青霉烯类抗生素不敏感大肠杆菌（CNSEc）菌血症的危险因素和临床结局。方法：我们在台湾北方一家拥有3,715张床位的三级医疗中心进行了一项配对病例对照研究。对照组为对碳青霉烯类药物敏感的大肠埃希菌感染患者，并与CNSEc菌血症进行配对。双变量分析显示，既往暴露于碳青霉烯类抗生素（p < 0.001）、入住重症监护室（p = 0.016）、中心静脉导管放置（p = 0.001）、慢性肝病（p < 0.001）、尿毒症定期透析（p = 0.004）和机械通气（p = 0.004）与CNSEc菌血症相关。多变量分析显示，既往暴露于碳青霉烯类抗生素[比值比（OR），29.17; 95%置信区间（Cl），1.76-484.70; p = 0.019]，尿毒症定期透析（OR，98.58; 95% CI，4.02-999; p = 0.005）和慢性肝病（OR，27.86; 95% CI，2.31-335.83; p = 0.009）是CNSEc菌血症的独立危险因素。与碳青霉烯类药物敏感的大肠埃希菌组相比，CNSEc组的住院时间更长（68.4天vs. 35.8天; p = 0.04），疾病严重程度更高，如匹兹堡菌血症评分大于或等于4所示（5.6% vs. 2.5%; p = 0.015）。CNSEc菌血症患者的总体住院死亡率较高（94.12%对50.00%; p = 0.002），但这两个group.Conclusions之间的28天死亡率没有差异：CNSEc菌血症将导致不良的结果与既往暴露于碳青霉烯类，慢性肝病，尿毒症定期透析的患者。版权所有（C）2011，台湾微生物学会。出版社：Elsevier Taiwan LLC All rights reserved.
Background: Infections due to carbapenem-resistant Enterobacteriaceae have been the emerging problem worldwide. This primary object of this study was to understand the risk factors and clinical outcomes of carbapenem-nonsusceptible Escherichia coli (CNSEc) bacteremia.Methods: We conducted a matched case control study in a 3,715-bed tertiary care medical center in northern Taiwan. The controls were selected among patients with carbapenemsusceptible E coli and were matched with CNSEc for bacteremia.Results: Fifty-one patients were included in this study (17 cases and 34 controls). Bivariate analysis showed that prior exposure to carbapenems (p < 0.001), stay in intensive care units (p = 0.016), placement of central venous catheters (p = 0.001), chronic liver diseases (p < 0.001), uremia with regular dialysis (p = 0.004), and mechanical ventilation (p = 0.004) were associated with CNSEc bacteremia. Multivariate analysis revealed that prior exposure to carbapenems [odds ratio (OR), 29.17; 95% confidence interval (Cl), 1.76-484.70; p = 0.019], uremia with regular dialysis (OR, 98.58; 95% Cl, 4.02-999; p = 0.005) and chronic liver diseases (OR, 27.86; 95% Cl, 2.31-335.83; p = 0.009) were independent risk factors for CNSEc bacteremia. Compared with carbapenem-susceptible E coli group, CNSEc group had a longer hospital stay (68.4 days vs. 35.8 days; p = 0.04) and a higher disease severity, as indicated by a Pittsburgh bacteremia score greater than or equal to 4 (5.6% vs. 2.5%; p = 0.015). Patients with CNSEc bacteremia had a higher overall in-hospital mortality rate (94.12% vs. 50.00%; p = 0.002), but there was no difference in the 28-day mortality between these two groups.Conclusions: CNSEc bacteremia would lead to a poor outcome among patients with prior exposure to carbapenems, chronic liver disease, and uremia with regular dialysis. Copyright (C) 2011, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. All rights reserved.