Neuman Mark I, Kelley Meera, Harper Marvin B, File Thomas M, Camargo Carlos A
Division of Emergency Medicine, Children's Hospital, Boston, Massachusetts 02115, USA.
J Emerg Med. 2007 May;32(4):349-57. doi: 10.1016/j.jemermed.2006.08.014. Epub 2007 Mar 30.
We conducted a multicenter, retrospective cohort study of patients with Streptococcus pneumoniae bacteremia to determine factors associated with antibiotic resistance and mortality. Risk factors were identified using multivariate logistic regression. There were 1574 patients at 34 sites enrolled. Compared to isolates from patients not receiving an antibiotic before the index blood culture, patients receiving an antibiotic were less likely to harbor an antibiotic susceptible organism. Susceptibility to penicillin decreased from 78% (95% confidence interval [CI] 75-80) to 49% (95% CI 39-59); to cefotaxime/ceftriaxone, from 92% (95% CI 90-93) to 82% (95% CI 72-89); and to macrolide, from 84% (95% CI 82-87) to 55% (95% CI 41-68). Factors associated with macrolide non-susceptibility include: > 24 h of antibiotic therapy at time of the index culture (odds ratio [OR] 4.0), residing in southern U.S. (OR 1.7), and having an antibiotic allergy (OR 1.7). Harboring an antibiotic non-susceptible strain (OR 1.4) and male sex (OR 1.4) were associated with increased risk of mortality, whereas black race (OR 0.6) and evidence of focal infection (OR 0.6) were associated with decreased risk.
我们开展了一项针对肺炎链球菌菌血症患者的多中心回顾性队列研究，以确定与抗生素耐药性及死亡率相关的因素。通过多变量逻辑回归分析确定风险因素。在34个地点共纳入了1574例患者。与在首次血培养前未接受抗生素治疗的患者的分离株相比，接受过抗生素治疗的患者携带抗生素敏感菌的可能性较小。对青霉素的敏感性从78%（95%置信区间[CI]75 - 80）降至49%（95%CI 39 - 59）；对头孢噻肟/头孢曲松的敏感性从92%（95%CI 90 - 93）降至82%（95%CI 72 - 89）；对大环内酯类的敏感性从84%（95%CI 82 - 87）降至55%（95%CI 41 - 68）。与大环内酯类不敏感相关的因素包括：在首次培养时抗生素治疗时间>24小时（比值比[OR]4.0）、居住在美国南部（OR 1.7）以及有抗生素过敏史（OR 1.7）。携带抗生素不敏感菌株（OR 1.4）和男性（OR 1.4）与死亡风险增加相关，而黑人种族（OR 0.6）和局灶性感染证据（OR 0.6）与死亡风险降低相关。
