Impact of inadequate initial antimicrobial therapy on mortality in infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae -: Variability by site of infection
Impact of inadequate initial antimicrobial therapy on mortality in infections due to extended-spectrum β-lactamase-producing Enterobacteriaceae -: Variability by site of infection
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DOI：
10.1001/archinte.165.12.1375
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发表时间：
2005-06-27
影响因子：
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通讯作者：
Lautenbach, E
中科院分区：
文献类型：
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作者：
Hyle, EP;Lipworth, AD;Lautenbach, E
背景：产超广谱β-内酰胺酶的大肠埃希菌和克雷伯氏菌(ESBL-EK)感染近年来明显增加。ESBL-EK感染死亡的危险因素尚未被研究。方法：这项回顾性队列研究是在一个有625个床位的三级保健医疗中心和一个有344个床位的城市社区医院进行的，以确定初始抗菌治疗(IIAT；从获得培养到开始使用感染微生物敏感的制剂之间的48小时)是否与ESBL-EK感染的死亡率有关。所有在1997年6月1日至2002年12月31日期间感染ESBL-EK的住院患者都符合纳入条件。随后，我们进行了嵌套式病例对照研究，以确定IIAT的危险因素。结果：187名受试者中，32名(17.1%)在住院期间死亡。在HAT和死亡率之间的关系中，临床感染部位是一个重要的影响因素。HAT的存在是死亡率的独立危险因素，但仅限于非尿路ESBL-EK感染(调整后的优势比[95%可信区间]，10.04[1.90-52.96])。HAT的独立危险因素是(1)多重耐药超广谱β-内酰胺酶感染(即对磺胺甲恶唑、氨基糖苷类和喹诺酮类药物耐药)(14.58[1.91~111.36])和(2)卫生保健获得性超广谱β-内酰胺酶感染(4.32[1.49~12.54])。结论：早期抗菌治疗不足是超广谱β-内酰胺酶感染的独立危险因素，但仅限于普通感染。多药耐药是HAT的重要危险因素。
Background: Infections due to extended-spectrum P-lactamase-producing Escherichia coli and Klebsiella species (ESBL-EK) have increased markedly in recent years. Risk factors for mortality among ESBL-EK infections have not been studied.Methods: This retrospective cohort study was conducted in a 625-bed tertiary care medical center and a 344-bed urban community hospital to determine whether inadequate initial antimicrobial therapy (IIAT) (>48 hours between the time a culture was obtained and initiation of an agent to which the infecting organism was susceptible) is associated with mortality in ESBL-EK infections. All hospitalized patients with an ESBL-EK infection between June 1, 1997, and December 31, 2002, were eligible for inclusion. Subsequently, we conducted a nested case-control study to identify risk factors for IIAT.Results: Of 187 subjects, 32 (17.1%) died while in the hospital. Clinical site of infection was a significant effect modifier in the association between HAT and mortality. The presence of HAT was an independent risk factor for mortality, but only for nonurinary ESBL-EK infections (adjusted odds ratio [95% confidence interval], 10.04 [1.90-52.96]). Independent risk factors for HAT were (1) infection with a multidrug-resistant ESBL-EK (ie, resistant to sulfamethoxazole-trimethoprim, aminoglycosides, and quinolones) (14.58 [1.91-111.36]) and (2) health care-acquired ESBL-EK infection (4.32 [1.49-12.54]).Conclusions: Inadequate initial antimicrobial therapy is an independent risk factor for mortality in ESBL-EK infections, but only among norturinary infections. Multidrug resistance was a strong risk factor for HAT.