Abbo A, Carmeli Y, Navon-Venezia S, Siegman-Igra Y, Schwaber M J
Division of Epidemiology, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, Tel Aviv, 64239, Israel.
Eur J Clin Microbiol Infect Dis. 2007 Nov;26(11):793-800. doi: 10.1007/s10096-007-0371-8.
We conducted a retrospective matched cohort study to examine the impact of isolation of multi-drug-resistant (MDR) Acinetobacter baumannii on patient outcomes. Cases from whom MDR A. baumannii was isolated in a clinical culture (n = 118) were compared with controls from whom MDR A. baumannii was not isolated (n = 118). Cases and controls were matched according to ward, calendar month of hospitalization, and duration of hospitalization before culture. The following outcomes were compared in multivariable analysis: in-hospital mortality, length of stay, need for mechanical ventilation, and functional status at discharge. MDR A. baumannii was determined to be a pathogen in 72% of cases. In 36% of cases, the patient died, versus 21% of controls (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.17-4.16, P = 0.014). Median length of stay for surviving cases was 17 days, versus 11 for surviving controls (multiplicative effect 1.55, 95% CI 0.99-2.44, P = 0.057). Fifty-two percent of cases required mechanical ventilation, versus 25% of controls (OR 3.72, 95% CI 1.91-7.25, P<0.001); 60% of surviving cases were discharged with reduced functional status, versus 38% of controls (OR 4.4, 95% CI 1.66-11.61, P = 0.003). In multivariable analysis, clinical isolation of MDR A. baumannii remained a significant predictor of mortality (OR 6.23, 95% CI 1.31-29.5, P = 0.021), need for mechanical ventilation (OR 7.34, 95% CI 2.24-24.0, P<0.001), and reduced functional status on discharge (OR 7.93, 95% CI 1.1-56.85, P = 0.039). Thus, MDR A. baumannii acquisition is associated with severe adverse outcomes, including increased mortality, need for mechanical ventilation, and reduced functional status.
我们进行了一项回顾性匹配队列研究，以检验多重耐药鲍曼不动杆菌的隔离对患者预后的影响。将临床培养中分离出多重耐药鲍曼不动杆菌的病例（n = 118）与未分离出多重耐药鲍曼不动杆菌的对照（n = 118）进行比较。根据病房、住院的日历月份以及培养前的住院时间对病例和对照进行匹配。在多变量分析中比较了以下预后指标：住院死亡率、住院时间、机械通气需求以及出院时的功能状态。72%的病例中多重耐药鲍曼不动杆菌被确定为病原体。36%的病例死亡，而对照为21%（比值比[OR] 2.21，95%置信区间[CI] 1.17 - 4.16，P = 0.014）。存活病例的中位住院时间为17天，而存活对照为11天（相乘效应1.55，95% CI 0.99 - 2.44，P = 0.057）。52%的病例需要机械通气，而对照为25%（OR 3.72，95% CI 1.91 - 7.25，P<0.001）；60%的存活病例出院时功能状态下降，而对照为38%（OR 4.4，95% CI 1.66 - 11.61，P = 0.003）。在多变量分析中，多重耐药鲍曼不动杆菌的临床隔离仍然是死亡率（OR 6.23，95% CI 1.31 - 29.5，P = 0.021）、机械通气需求（OR 7.34，95% CI 2.24 - 24.0，P<0.001）以及出院时功能状态下降（OR 7.93，95% CI 1.1 - 56.85，P = 0.039）的显著预测因素。因此，获得多重耐药鲍曼不动杆菌与严重不良预后相关，包括死亡率增加、机械通气需求增加以及功能状态下降。
