Risk Factors for Mortality Associated With Enterococcal Bloodstream Infections
Risk Factors for Mortality Associated With Enterococcal Bloodstream Infections
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肠球菌血流感染相关死亡的危险因素
DOI：
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发表时间：
1996
期刊：
影响因子：
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通讯作者：
R. Gaynes
中科院分区：
文献类型：
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作者：
L. Stroud;J. Edwards;L. Danzig;D. Culver;R. Gaynes
摘要目的：确定院内肠球菌原发性血流感染（EPBI）患者死亡的危险因素，并评估万古霉素耐药是否使患者死亡风险增加。设计/设置：回顾性队列研究，在四个国家医院感染监测系统的医院进行。结果：在145例EPBI患者中，74例（51%）死亡，26例（18%）具有万古霉素耐药菌株。在比较存活与死亡的EPBI患者时，未发现死亡率与既往侵入性器械使用、手术史、既往医院感染类型或数量、感染前住院时间或接受万古霉素治疗之间存在相关性。死亡率的独立预测因素是疾病严重程度指数（APACHE II评分和合并症加权指数）、年龄、感染前一周内使用第三代头孢菌素或甲硝唑以及女性。结论：万古霉素耐药不是死亡的独立预测因子，其作用难以确定，因为队列患者是所有住院患者中病情最严重的患者。肠球菌原发性血流感染似乎表明严重的，危及生命的疾病过程。肠球菌的致病性和万古霉素耐药作为EPBI患者死亡原因的作用需要进一步评估。
Abstract Objective: To determine risk factors for mortality in patients with a nosocomial enterococcal primary bloodstream infection (EPBI) and to assess whether vancomycin resistance placed a patient at increased risk of death. Design/Setting: A retrospective cohort study was conducted in four National Nosocomial Infection Surveillance System hospitals. Results: Of 145 patients identified with EPBIs, 74 (51%) died, and 26 (18%) had a vancomycin-resistant isolate. Upon comparing patients with EPBIs who survived to those who died, no associations were found between mortality and prior invasive device use, procedure history, type or number of prior nosocomial infections, length of hospitalization before infection, or receipt of vancomycin. Independent predictors of mortality were indices of severity of illness (APACHE II score and comorbidity weighted index), age, the use of third-generation cephalosporins or metronidazole during the week prior to infection, and female gender. Conclusions: Vancomycin resistance was not an independent predictor of death, and its role was difficult to establish, because cohort patients were among the most severely ill of all hospitalized patients. Enterococcal primary bloodstream infections appear to indicate severe, life-threatening disease processes. The pathogenicity of enterococci and the role of vancomycin resistance as a cause of mortality in patients with EPBIs need to be assessed further.