Derivation and validation of clinical prediction rules for reduced vancomycin susceptibility in Staphylococcus aureus bacteraemia.
Derivation and validation of clinical prediction rules for reduced vancomycin susceptibility in Staphylococcus aureus bacteraemia.
复制标题
金黄色葡萄球菌菌血症万古霉素敏感性降低的临床预测规则的推导和验证。
DOI：
10.1017/s0950268812000295
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发表时间：
2013
影响因子：
4.2
通讯作者：
Lautenbach,E
中科院分区：
文献类型：
--
作者：
Han,JH;Bilker,WB;Edelstein,PH;Mascitti,KB;Lautenbach,E
万古霉素敏感性降低（RVS）可能导致金黄色葡萄球菌菌血症的临床结局较差。我们对392例S.金黄色葡萄球菌菌血症在一所大学的卫生系统。通过Etest [万古霉素最低抑菌浓度（MIC）> 1.0 μg/ml]和肉汤微量稀释法（万古霉素MIC> 1.0 μg/ml）定义的RVS与患者和临床变量之间的相关性进行评估，以创建RVS的单独预测模型。总共有134例（34.2%）和73例（18.6%）患者患有S。分别用Etest法和肉汤微量稀释法测定金黄色葡萄球菌分离株与RVS的关系。通过Etest的RVS最终模型包括甲氧西林耐药[比值比（OR）1.51，95%置信区间（CI）0.97 - 2.34]，非白人（OR 0·67，95% CI 0·42-1·07），医疗相关感染（OR 0·56，95% CI 0·32-0·96），在培养日期前30天接受任何抗菌治疗（OR 3·06，95% CI 1·72-5·44）。通过肉汤微量稀释法建立的RVS最终模型包括甲氧西林耐药性（OR 2.45，95%CI 1.42 - 4.24），急诊入院（OR 0·54，95% CI 0·32-0·92）、存在血管内器械（OR 2·24，95% CI 1·30-3·86）和恶性肿瘤（OR 0·51，95% CI 0·26-1·00）。RVS的早期识别的一个简单和快速的临床预测规则的可用性可以用来帮助指导这些严重感染的及时和个性化的管理。
Reduced vancomycin susceptibility (RVS) may lead to poor clinical outcomes in Staphylococcus aureus bacteraemia. We conducted a cohort study of 392 patients with S. aureus bacteraemia within a university health system. The association between RVS, as defined by both Etest [vancomycin minimum inhibitory concentration (MIC) >1·0 μg/ml] and broth microdilution (vancomycin MIC ⩾1·0 μg/ml), and patient and clinical variables were evaluated to create separate predictive models for RVS. In total, 134 (34·2%) and 73 (18·6%) patients had S. aureus isolates with RVS by Etest and broth microdilution, respectively. The final model for RVS by Etest included methicillin resistance [odds ratio (OR) 1·51, 95% confidence interval (CI) 0·97–2·34], non-white race (OR 0·67, 95% CI 0·42–1·07), healthcare-associated infection (OR 0·56, 95% CI 0·32–0·96), and receipt of any antimicrobial therapy ⩽30 days prior to the culture date (OR 3·06, 95% CI 1·72–5·44). The final model for RVS by broth microdilution included methicillin resistance (OR 2·45, 95% CI 1·42–4·24), admission through the emergency department (OR 0·54, 95% CI 0·32–0·92), presence of an intravascular device (OR 2·24, 95% CI 1·30–3·86), and malignancy (OR 0·51, 95% CI 0·26–1·00). The availability of an easy and rapid clinical prediction rule for early identification of RVS can be used to help guide the timely and individualized management of these serious infections.