Schramm Garrett E, Johnson Jennifer A, Doherty Joshua A, Micek Scott T, Kollef Marin H
Critical Care Specialty Resident, Barnes-Jewish Hospital, St. Louis, MO, USA.
Crit Care Med. 2006 Aug;34(8):2069-74. doi: 10.1097/01.CCM.0000227655.41566.3E.
The first goal of this investigation was to determine the rate of appropriate initial antimicrobial administration to patients with methicillin-resistant Staphylococcus aureus (MRSA) sterile-site infections. Our second goal was to evaluate the influence of appropriate initial treatment of MRSA sterile-site infection on outcome.
A retrospective, single-center, observational cohort study.
Barnes-Jewish Hospital, a 1200-bed urban teaching facility.
Adult patients requiring hospitalization identified to have an MRSA sterile-site infection.
Retrospective data collection from automated hospital and pharmacy databases.
Five hundred forty-nine patients with S. aureus sterile site infections were identified during a 3-yr period (January 2002 through December 2004). One hundred twenty-seven (23.1%) died during hospitalization. Hospital mortality was statistically greater for patients receiving inappropriate initial antimicrobial treatment (n = 380) within 24 hrs of a positive culture than for those receiving appropriate initial treatment (n = 169) (26.1% vs. 16.6%; p = .015). Multiple logistic regression analysis identified inappropriate initial antimicrobial treatment (adjusted odds ratio [AOR], 1.92; 95% confidence interval [CI], 1.48-2.50; p = .0134), vasopressor administration (AOR, 5.49; 95% CI, 4.08-7.38; p < .001), and increasing age (1-yr increments) (AOR, 1.03; 95% CI, 1.02-1.04; p < .001) as independent determinants of hospital mortality.
Inappropriate initial antimicrobial treatment of MRSA sterile-site infections is common and is associated with an increased risk of hospital mortality. Appropriate antimicrobial treatment of MRSA sterile-site infections may be maximized by increased use of initial empirical antimicrobial treatment regimens targeting MRSA in patients at risk for this infection until organism identification and susceptibility become known.
本研究的首要目标是确定耐甲氧西林金黄色葡萄球菌（MRSA）无菌部位感染患者初始抗菌药物合理使用的比例。我们的第二个目标是评估MRSA无菌部位感染的初始合理治疗对预后的影响。
一项回顾性、单中心观察性队列研究。
巴恩斯犹太医院，一家拥有1200张床位的城市教学医院。
确诊患有MRSA无菌部位感染的成年住院患者。
从医院自动化数据库和药房数据库中进行回顾性数据收集。
在3年期间（2002年1月至2004年12月）共识别出549例金黄色葡萄球菌无菌部位感染患者。127例（23.1%）在住院期间死亡。培养结果阳性后24小时内接受不恰当初始抗菌治疗的患者（n = 380）的医院死亡率在统计学上高于接受恰当初始治疗的患者（n = 169）（26.1%对16.6%；p = 0.015）。多因素逻辑回归分析确定不恰当的初始抗菌治疗（校正比值比[AOR]，1.92；95%置信区间[CI]，1.48 - 2.50；p = 0.0134）、血管活性药物的使用（AOR，5.49；95% CI，4.08 - 7.38；p < 0.001）以及年龄增长（每年增加1岁）（AOR，1.03；95% CI，1.02 - 1.04；p < 0.0
