Clinical significance of healthcare-associated infections in community-onset Escherichia coli bacteraemia
Clinical significance of healthcare-associated infections in community-onset Escherichia coli bacteraemia
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DOI：
10.1093/jac/dkm378
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发表时间：
2007-12-01
影响因子：
5.2
通讯作者：
Peck, Kyong Ran
中科院分区：
文献类型：
--
作者：
Cheong, Hae Suk;Kang, Cheol-In;Peck, Kyong Ran
背景资料：大肠埃希菌感染的耐药性日益增加是一个非常令人关注的问题，即使是社区发病的infecties.Methods：我们进行了一项回顾性队列研究的患者与大肠埃希菌。2002年2月至2005年12月期间访问三星医疗中心急诊科的2000名患者中，有200人患有大肠杆菌菌血症，以确定死亡率的危险因素以及医疗相关（HCA）感染与死亡率之间的关系。我们将社区发病的E.结果：508例大肠埃希菌血症患者中，社区获得性（CA）感染和HCA感染的比例分别为100%和100%。入选的患者均为大肠杆菌血症患者（平均年龄61.8 ± 14.3岁;男/女比例191：317）。HCA E.大肠杆菌菌血症的病情严重程度和耐药率明显高于CA菌血症。30 d病死率为13.6%（69/508），HCA感染病死率为26.4%，显著高于CA感染的9.6%（P < 0.001）。在多变量分析中，高Charlson共病指数（OR 4.84，95%CI 2.14-10.95，P < 0.001），Pitt菌血症评分高（OR 32.03，95%CI 13.08-74.43，P < 0.001），表现为急性肾功能衰竭HCA菌血症（OR 2.34，95% CI 1.09-5.01，P = 0.030）是大肠埃希菌30 d死亡的重要危险因素。结论：HCA大肠杆菌菌血症死亡率高，大肠杆菌菌血症是CA菌血症的两倍多，HCA菌血症是死亡率的重要危险因素之一，即使调整了大量潜在的混杂因素。
Background: The increasing antimicrobial resistance of Escherichia coli infection is of great concern, even for community-onset infections.Methods: We conducted a retrospective cohort study of patients with E. coli bacteraemia who visited the emergency department of the Samsung Medical Center from February 2002 to December 2005 to identify the risk factors for mortality and association between healthcare-associated (HCA) infection and mortality. We classified community-onset E. coli bacteraemia into community-acquired (CA) and HCA infections.Results: A total of 508 patients with E. coli bacteraemia were enrolled (mean age, 61.8 +/- 14.3 years; male/female, 191:317). The HCA E. coli bacteraemia had significantly higher severity of illness and higher antimicrobial resistance rate than CA bacteraemia. The overall 30-day mortality rate was 13.6% (69/508) and the mortality of HCA infections was significantly higher than that of CA infections (26.4% versus 9.6%, P < 0.001). In multivariate analysis, high Charlson's co-morbidity index (OR 4.84, 95% CI 2.14-10.95, P < 0.001), high Pitt bacteraemia score (OR 32.03, 95% CI 13.08-74.43, P < 0.001), presentation with acute renal failure (OR 4.11, 95% CI 1.90-8.89, P < 0.001) and HCA bacteraemia (OR 2.34, 95% CI 1.09-5.01, P = 0.030) were found to be the significant risk factors for 30-day mortality in E. coli bacteraemia.Conclusions: The mortality rate of HCA E. coli bacteraemia was higher than twice that of CA bacteraemia and HCA bacteraemia was one of the significant risk factors for mortality, even after adjusting for a large number of potential confounders.