The management of Staphylococcus aureus bacteremia in the United Kingdom and Vietnam: a multi-centre evaluation.
The management of Staphylococcus aureus bacteremia in the United Kingdom and Vietnam: a multi-centre evaluation.
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DOI：
10.1371/journal.pone.0014170
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发表时间：
2010-12-13
期刊：
影响因子：
3.7
通讯作者：
United Kingdom Clinical Infection Research Group (UKCIRG)
中科院分区：
文献类型：
--
作者：
Thwaites GE;United Kingdom Clinical Infection Research Group (UKCIRG)
金黄色葡萄球菌菌血症是世界范围内常见且严重的感染，尽管存在治疗指南，但在最佳管理方面几乎没有共识。在这项研究中，我们评估了金黄色葡萄球菌菌血症的管理和遵守治疗指南的变化。我们前瞻性地记录了在英国8个中心、越南3个中心和尼泊尔1个中心连续一年治疗的所有金黄色葡萄球菌菌血症成人的基线临床特征、管理和住院结果。630名成人接受了金黄色葡萄球菌菌血症治疗：英国549人（21%耐甲氧西林）、越南80人（19%耐甲氧西林）和尼泊尔1人。在英国，41%的患者有可移动的感染灶（50%与静脉导管有关），而越南为12%。英国患者接受超声心动图检查的比例显著（p<0.001）高于越南患者（50%对28%），接受超过14天抗生素治疗的比例（84%对44%），接受单独口服抗生素治疗的比例为50%（25%对4%）。在英国各中心，单独口服治疗占治疗的50%（范围12-40%）、治疗时间超过28天的患者（范围13-54%）和联合治疗患者（范围14-94%）的比例差异显著（p<0.01）。24%在入院时死亡：年龄较大、菌血症前住院时间和不明感染病灶是院内死亡的独立预测因素（p<0.001）。金黄色葡萄球菌菌血症的管理在英国和越南之间以及英国各中心之间差异很大，几乎没有遵守已公布的指导方针。迫切需要确定最佳治疗方法的对照试验。
Staphylococcus aureus bacteremia is a common and serious infection worldwide and although treatment guidelines exist, there is little consensus on optimal management. In this study we assessed the variation in management and adherence to treatment guidelines of S. aureus bacteremia. We prospectively recorded baseline clinical characteristics, management, and in-hospital outcome of all adults with S. aureus bacteremia treated consecutively over one year in eight centres in the United Kingdom, three in Vietnam and one in Nepal. 630 adults were treated for S. aureus bacteremia: 549 in the UK (21% methicillin-resistant), 80 in Vietnam (19% methicillin-resistant) and 1 in Nepal. In the UK, 41% had a removable infection focus (50% intravenous catheter-related), compared to 12% in Vietnam. Significantly (p<0.001) higher proportions of UK than Vietnamese patients had an echocardiogram (50% versus 28%), received more than 14 days antibiotic therapy (84% versus 44%), and received >50% of treatment with oral antibiotics alone (25% versus 4%). UK centres varied significantly (p<0.01) in the proportions given oral treatment alone for >50% of treatment (range 12–40%), in those treated for longer than 28 days (range 13–54%), and in those given combination therapy (range 14–94%). 24% died during admission: older age, time in hospital before bacteremia, and an unidentified infection focus were independent predictors of in-hospital death (p<0.001). The management of S. aureus bacteremia varies widely between the UK and Vietnam and between centres in the UK with little adherence to published guidelines. Controlled trials defining optimal therapy are urgently required.