Bhavnani S M, Drake J A, Forrest A, Deinhart J A, Jones R N, Biedenbach D J, Ballow C H
The Clinical Pharmacokinetics Laboratory, Millard Fillmore Hospital/Kaleida Health, Buffalo, New York, USA.
Diagn Microbiol Infect Dis. 2000 Mar;36(3):145-58. doi: 10.1016/s0732-8893(99)00136-4.
National Nosocomial Resistance Surveillance Group participants from 22 hospitals across the United States reviewed medical records for hospitalized patients with vancomycin-resistant enterococcal (VRE) or vancomycin-susceptible enterococcal (VSE) bacteremia to identify risk factors associated with the acquisition of VRE bacteremia, describe genetic traits of VRE strains, and identify factors predictive of clinical outcome. VRE cases were matched to VSE controls within each institution. Multiple logistic regression (LR) and classification and regression tree (CART) analysis were used to probe for factors associated with VRE bacteremia and clinical outcome. A total of 150 matched-pairs of VRE cases and VSE controls were collected from 1995 to 1997. Using LR, the following were found to be highly associated with VRE bacteremia: history of AIDS, positive HIV status, or drug abuse (OR 9.58); prior exposure with parenteral vancomycin (OR 8.37); and liver transplant history (OR 6. 75). CART analysis revealed that isolation of Enterococcus faecium, prior vancomycin exposure, and serum creatinine values > or = 1.1 mg/dl were predictors of VRE bacteremia. Greater proportions of clinical failure (60% versus 40%, P < 0.001) and all-cause mortality (52% versus 27%, P < 0.001) were seen in patients with VRE versus VSE bacteremia. Results from both LR and CART indicated that patients with persisting enterococcal bacteremia, intubation at baseline, higher APACHE II scores, and VRE bacteremia were at greater risk for poor outcome.
美国全国医院耐药监测组的成员来自美国各地的22家医院，他们查阅了耐万古霉素肠球菌（VRE）或万古霉素敏感肠球菌（VSE）菌血症住院患者的病历，以确定与VRE菌血症获得相关的危险因素，描述VRE菌株的遗传特征，并确定预测临床结局的因素。在每个机构内，将VRE病例与VSE对照进行匹配。使用多因素逻辑回归（LR）和分类与回归树（CART）分析来探究与VRE菌血症和临床结局相关的因素。1995年至1997年共收集了150对匹配的VRE病例和VSE对照。使用LR发现，以下因素与VRE菌血症高度相关：艾滋病病史、HIV阳性状态或药物滥用（比值比9.58）；先前接受过胃肠外万古霉素治疗（比值比8.37）；以及肝移植病史（比值比6.75）。CART分析显示，粪肠球菌的分离、先前的万古霉素暴露以及血清肌酐值≥1.1mg/dl是VRE菌血症的预测因素。VRE菌血症患者的临床失败比例（60%对40%，P<0.001）和全因死亡率（52%对27%，P<0.001）高于VSE菌血症患者。LR和CART的结果均表明，持续性肠球菌菌血症患者、基线时插管、较高的急性生理学与慢性健康状况评分系统（APACHE II）评分以及VRE菌血症患者预后不良的风险更高。
