Impact of fluoroquinolone resistance in Gram-negative bloodstream infections on healthcare utilization
Impact of fluoroquinolone resistance in Gram-negative bloodstream infections on healthcare utilization
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DOI：
10.1016/j.cmi.2015.05.013
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发表时间：
2015-09-01
影响因子：
14.2
通讯作者：
Al-Hasan, M. N.
中科院分区：
文献类型：
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作者：
Brigmon, M. M.;Bookstaver, P. Brandon;Al-Hasan, M. N.
革兰氏阴性血流分离株对氟喹诺酮类药物的耐药性增加令人担忧。这项回顾性队列研究探讨了革兰氏阴性血流感染（BSI）患者对氟喹诺酮类药物耐药对医疗资源使用的影响。确定了2010年至2012年在美国南卡罗来纳州哥伦比亚的棕榈Health Hospitals首次发生社区发病革兰氏阴性BSI的住院成人。采用多元线性回归分析研究革兰氏阴性BSI幸存者住院时间延长（HLOS）的危险因素。在474例独特患者中，分别有384例（81%）和90例（19%）因氟喹诺酮敏感（EST-S）和氟喹诺酮非敏感（EST-NS）革兰阴性杆菌而发生BSI。EST-NS血流分离株，特别是大肠杆菌，比EST-S分离株更可能是多药耐药的（56%对6%，p < 0.001）。与血液中分离出BS-S的BSI患者相比，分离出BS-NS的患者更可能接受不适当的经验性抗菌治疗（26%对3%，p < 0.001），平均HLOS较长（11.6 vs 9.3天，p 0.03）和住院期间静脉抗生素治疗持续时间（9.1 vs 7.1天，p 0.001），出院时使用门诊静脉注射抗生素（15% vs 8%，p 0.05）。在多变量模型中调整后，不适当的经验性抗菌治疗是革兰氏阴性BSI幸存者延长HLOS的独立风险因素（参数估计值为3.65天，95%CI 0.43-6.86）。多重耐药性之间的EST-NS血流分离物限制了经验和确定的抗菌治疗方案，并对医疗保健系统造成了过度的负担。临床微生物学和感染（C）2015年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
There has been a concerning increase in fluoroquinolone resistance among Gram-negative bloodstream isolates. This retrospective cohort study examines the implications of fluoroquinolone resistance on use of healthcare resources in patients with Gram-negative bloodstream infections (BSI). Hospitalized adults with first episodes of community-onset Gram-negative BSI from 2010 to 2012 at Palmetto Health Hospitals in Columbia, SC, USA were identified. Multivariate linear regression was used to examine risk factors for prolonged hospital length of stay (HLOS) in survivors of Gram-negative BSI. Among 474 unique patients, 384 (81%) and 90 (19%) had BSI due to fluoroquinolone-susceptible (FQ-S) and fluoroquinolone non-susceptible (FQ-NS) Gram-negative bacilli, respectively. The FQ-NS bloodstream isolates, particularly Escherichia coli, were more likely than FQ-S isolates to be multi-drug resistant (56% versus 6%, p < 0.001). Compared with patients with BSI due to FQ-S bloodstream isolates, those with FQ-NS isolates were more likely to receive inappropriate empirical antimicrobial therapy (26% versus 3%, p < 0.001), have longer mean HLOS (11.6 versus 9.3 days, p 0.03) and treatment duration with intravenous antibiotics during hospitalization (9.1 versus 7.1 days, p 0.001), and use outpatient intravenous antibiotics at hospital discharge (15% versus 8%, p 0.05). After adjustments in the multivariate model, inappropriate empirical antimicrobial therapy was an independent risk factor for prolonged HLOS in survivors of Gram-negative BSI (parameter estimate 3.65 days, 95% CI 0.43-6.86). Multi-drug resistance among FQ-NS bloodstream isolates limits both empirical and definitive antimicrobial treatment options and poses excessive burdens on the healthcare system. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.