Clinical and economic impact of bacteremia with extended-spectrum-β-lactamase-producing Enterobacteriaceae
Clinical and economic impact of bacteremia with extended-spectrum-β-lactamase-producing Enterobacteriaceae
复制标题
DOI：
10.1128/aac.50.4.1257-1262.2006
复制
发表时间：
2006-04-01
影响因子：
4.9
通讯作者：
Carmeli, Y
中科院分区：
文献类型：
--
作者：
Schwaber, MJ;Navon-Venezia, S;Carmeli, Y
我们研究了产超广谱β-内酰胺酶（ESBL）肠杆菌科菌血症的结果。由产ESBL大肠埃希菌、克雷伯菌属引起的菌血症住院患者，或变形杆菌属（Proteus spp.）并与非产ESBL菌引起的菌血症患者（对照组）进行比较。结局包括死亡率、感染死亡率、住院时间（LOS）、适当治疗延迟（DAT）、出院至慢性护理机构和住院费用。共入组99例病例和99例对照。35%的病例死亡，而对照组为18%（比值比[OR]，2.5; 95%置信区间[CI]，1.3至4.7; P = 0.01）。30%的病例死于感染，而对照组为16%（OR，2.3; 95%CI，1.1 - 4.5; P = 0.03）。病例组菌血症后的中位LOS为11天（四分位距，5 - 21），对照组为5天（四分位距，3 - 9）（P < 0.001）。DAT发生率为66%，对照组为7%（OR，25.1; 95%CI，10.5 - 60.2; P < 0.001）。与对照组相比，病例组更有可能出院接受长期护理（52% vs 21%; OR，4.0; 95%CI，1.9 - 8.3; P < 0.001）。病例的平均住院费用为65，509以色列谢克尔，对照组为23，538谢克尔（P < 0.001）。通过多变量分析校正组间差异后，ESBL产生仍然是死亡率的重要预测因素（OR，3.6; 95% CI，1.4 - 9.5; P = 0.008），LOS增加DAT（OR，25.1; 95%CI，10.5 - 60.2; P < 0.001）和成本增加（1.57倍; P = 0.003）。可归因于ESBL生产的等效成本的平均增加为9，620美元。ESBL的产生与严重的不良结局相关，包括较高的总体死亡率和感染相关死亡率、LOS、DAT增加、出院至慢性护理以及较高的费用。
We studied outcomes of extended-spectrum P-lactamase (ESBL) production in Enterobacteriaceae bacteremia. Inpatients with bacteremia caused by ESBL-producing Escherichia coli, Klebsiella spp., or Proteus spp. (cases) were compared with patients with bacteremia caused by non-ESBL producers (controls). Outcomes included mortality, mortality due to infection, length of stay (LOS), delay in appropriate therapy (DAT), discharge to a chronic care facility, and hospital cost. Ninety-nine cases and 99 controls were enrolled. Thirty-five percent of cases died, versus 18% of controls (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.3 to 4.7; P = 0.01). Thirty percent of cases died due to infection, versus 16% of controls (OR, 2.3; 95% CI, 1.1 to 4.5; P = 0.03). The median LOS after bacteremia for cases was 11 days (interquartile range, 5 to 21), versus 5 days for controls (interquartile range, 3 to 9) (P < 0.001). DAT occurred in 66% of cases, versus 7% of controls (OR, 25.1; 95% CI, 10.5 to 60.2; P < 0.001). Cases were more likely than controls to be discharged to chronic care (52% versus 21%; OR, 4.0; 95% CI, 1.9 to 8.3; P < 0.001). The average hospital cost for cases was 65,509 Israeli shekels, versus 23,538 shekels for controls (P < 0.001). After adjusting for differences between groups by using multivariable analysis, ESBL production remained a significant predictor of mortality (OR, 3.6; 95% CI, 1.4 to 9.5; P = 0.008), increased LOS (1.56-fold; P = 0.001), DAT (OR, 25.1; 95% CI, 10.5 to 60.2; P < 0.001), and increased cost (1.57-fold; P = 0.003). The mean increase in equivalent cost attributable to ESBL production was $9,620. ESBL production was associated with severe adverse outcomes, including higher overall and infection-related mortality, increased LOS, DAT, discharge to chronic care, and higher costs.