Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: Risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome
Bloodstream infections caused by antibiotic-resistant gram-negative bacilli: Risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome
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DOI：
10.1128/aac.49.2.760-766.2005
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发表时间：
2005-02-01
影响因子：
4.9
通讯作者：
Choe, KW
中科院分区：
文献类型：
--
作者：
Kang, CI;Kim, SH;Choe, KW
近年来，抗生素耐药性革兰氏阴性杆菌引起的感染发生率显着增加，引起了人们的极大关注，因为被这些分离株感染的患者最初可能会接受对致病病原体无活性的抗生素。为了评估不适当的初始抗菌治疗对生存的影响，对286例抗生素耐药革兰氏阴性菌血症患者、61例大肠杆菌菌血症患者、65例肺炎克雷伯菌菌血症患者、74例铜绿假单胞菌菌血症患者和86例肠杆菌菌血症患者进行了回顾性分析。如果患者在血培养收集后 24 It 内接受了至少一种致病微生物对其敏感的抗菌药物，则认为初始抗菌治疗是适当的。菌血症的高风险来源被定义为肺、腹膜或未知来源。主要结果指标是 30 天死亡率。在 286 名患者中，135 名（47.2%）患者接受了适当的初始经验性抗菌治疗，其余 151 名（52.8%）患者接受了不适当的治疗。治疗充分组的死亡率为 27.4%，而治疗不充分组的死亡率为 38.4%（P = 0.049）。多变量分析显示，死亡的显着独立危险因素是脓毒性休克、菌血症的高危来源、铜绿假单胞菌感染和APACHE II评分升高。在具有菌血症高风险源的患者亚组中（n = 132），不适当的初始抗菌治疗与死亡率增加独立相关（比值比，3.64；95% 置信区间，1.13 至 11.72；P = 0.030）。我们的数据表明，不适当的初始抗菌治疗与抗生素耐药革兰氏阴性菌血症的不良后果相关，特别是对于菌血症高风险源的患者。
The marked increase in the incidence of infections due to antibiotic-resistant gram-negative bacilli in recent years is of great concern, as patients infected by those isolates might initially receive antibiotics that are inactive against the responsible pathogens. To evaluate the effect of inappropriate initial antimicrobial therapy on survival, a total of 286 patients with antibiotic-resistant gram-negative bacteremia, 61 patients with Escherichia coli bacteremia, 65 with Klebsiella pneumoniae bacteremia, 74 with Pseudomonas aeruginosa bacteremia, and 86 with Enterobacter bacteremia, were analyzed retrospectively. If a patient received at least one antimicrobial agent to which the causative microorganisms were susceptible within 24 It of blood culture collection, the initial antimicrobial therapy was considered to have been appropriate. High-risk sources of bacteremia were defined as the lung, peritoneum, or an unknown source. The main outcome measure was 30-day mortality. Of the 286 patients, 135 (47.2%) received appropriate initial empirical antimicrobial therapy, and the remaining 151 (52.8%) patients received inappropriate therapy. The adequately treated group had a 27.4% mortality rate, whereas the inadequately treated group had a 38.4% mortality rate (P = 0.049). Multivariate analysis showed that the significant independent risk factors of mortality were presentation with septic shock, a high-risk source of bacteremia, P. aeruginosa infection, and an increasing APACHE II score. In the subgroup of patients (n = 132) with a high-risk source of bacteremia, inappropriate initial antimicrobial therapy was independently associated with increased mortality (odds ratio, 3.64; 95% confidence interval, 1.13 to 11.72; P = 0.030). Our data suggest that inappropriate initial antimicrobial therapy is associated with adverse outcome in antibiotic-resistant gram-negative bacteremia, particularly in patients with a high-risk source of bacteremia.