Kreisel Kristen, Boyd Kristina, Langenberg Patricia, Roghmann Mary-Claire
Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore, MD 21201, USA.
Diagn Microbiol Infect Dis. 2006 Jul;55(3):179-84. doi: 10.1016/j.diagmicrobio.2006.01.021. Epub 2006 May 2.
Recurrence is a common complication of Staphylococcus aureus infections. A shorter duration of antibiotic treatment for a S. aureus infection has been previously suggested as a possible risk factor for recurrence. We conducted a retrospective cohort study of patients with S. aureus infection complicated by bacteremia who survived their initial treatment (N = 397) at the VA Maryland Health Care System from 1995 to 2004 to determine if 2 weeks or less of antibiotic therapy is significantly associated with a higher rate of recurrence. Recurrence was defined as recurrence of infection because of S. aureus with the same susceptibility to methicillin within 1 year of treatment of the initial bacteremia. Seventeen percent of patients who survived their initial infection had a recurrence of infection. Mean duration of antibiotic therapy in those who recurred was longer than in those who did not recur (21 versus 18 days, P = .18). No evidence was found to support an association between a duration of therapy of 14 days or less and an increased risk for recurrence (RR, 0.68; 95% CI, 0.44-1.04). However, being HIV infected (OR, 4.59; 95% CI, 1.61-13.10), having diabetes (OR, 2.02; 95% CI, 1.13-3.61) and having an infection due to a methicillin-resistant S. aureus (MRSA) (OR, 2.11; 95% CI, 1.17-3.80) were independent risk factors for recurrence. In conclusion, 2 weeks or less of antibiotic therapy was not associated with an increased risk for recurrence. However, patients with diabetes or HIV infection and patients with MRSA infections are at an increased risk for recurrence and should be followed more closely.
复发是金黄色葡萄球菌感染的常见并发症。先前曾提出，金黄色葡萄球菌感染的抗生素治疗疗程较短可能是复发的一个风险因素。我们对1995年至2004年在马里兰州退伍军人医疗保健系统中接受初始治疗后存活的金黄色葡萄球菌感染合并菌血症患者进行了一项回顾性队列研究（N = 397），以确定抗生素治疗2周或更短时间是否与较高的复发率显著相关。复发定义为在初始菌血症治疗后1年内，因对甲氧西林敏感性相同的金黄色葡萄球菌而再次感染。初始感染存活的患者中有17%发生了感染复发。复发患者的抗生素治疗平均疗程长于未复发患者（21天对18天，P = 0.18）。未发现证据支持治疗疗程为14天或更短与复发风险增加之间存在关联（相对危险度，0.68；95%可信区间，0.44 - 1.04）。然而，感染人类免疫缺陷病毒（HIV）（比值比，4.59；95%可信区间，1.61 - 13.10）、患有糖尿病（比值比，2.02；95%可信区间，1.13 - 3.61）以及感染耐甲氧西林金黄色葡萄球菌（MRSA）（比值比，2.11；95%可信区间，1.17 - 3.80）是复发的独立危险因素。总之，抗生素治疗2周或更短时间与复发风险增加无关。然而，糖尿病或HIV感染患者以及MRSA感染患者复发风险增加，应进行更密切的随访。
