Kopterides Petros, Koletsi Patra K, Michalopoulos Argyris, Falagas Matthew E
Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Str., 151 23 Marousi, Athens, Greece.
Int J Antimicrob Agents. 2007 Nov;30(5):409-14. doi: 10.1016/j.ijantimicag.2007.06.026. Epub 2007 Sep 11.
In this study, we explored risk factors associated with bacteraemia caused by colistin-susceptible/carbapenem-resistant (Co(S)/Ca(R)) Acinetobacter baumannii. A retrospective cohort study of hospitalised patients with A. baumannii bacteraemia was performed at a tertiary care hospital over a 44-month period. Thirty-nine patients with bacteraemia due to A. baumannii (35 Intensive Care Unit and 4 ward patients) were included in the analysis. Twenty-five patients (64%) had bacteraemia due to Co(S)/Ca(R)A. baumannii and 14 patients (36%) had bacteraemia due to colistin-susceptible/carbapenem-susceptible A. baumannii. Mortality was 56% (14/25) and 35.7% (5/14) for patients in the two groups, respectively (P=0.22). Bivariate analysis showed that prior exposure to fluoroquinolones (P=0.01) and antipseudomonal penicillins (P=0.004) as well as a higher number of antibiotics in use on the day of bacteraemia (P=0.02) were associated with isolation of a Co(S)/Ca(R) strain among patients with A. baumannii bacteraemia. Multivariate analysis using a backward logistic regression model showed that only exposure to fluoroquinolones was associated with development of Co(S)/Ca(R)A. baumannii bacteraemia (odds ratio=11.6; 95% confidence interval 2.4-55.9; P=0.02). The appearance of Co(S)/Ca(R)A. baumannii infections represents a major threat to critically ill hospitalised patients. Exposure to fluoroquinolones is an independent risk factor for development of Co(S)/Ca(R)A. baumannii bacteraemia.
在本研究中，我们探究了与对黏菌素敏感/对碳青霉烯耐药（Co(S)/Ca(R)）鲍曼不动杆菌所致菌血症相关的危险因素。在一家三级护理医院对住院的鲍曼不动杆菌菌血症患者进行了一项为期44个月的回顾性队列研究。分析纳入了39例鲍曼不动杆菌菌血症患者（35例重症监护病房患者和4例普通病房患者）。25例患者（64%）的菌血症由Co(S)/Ca(R)鲍曼不动杆菌引起，14例患者（36%）的菌血症由对黏菌素敏感/对碳青霉烯敏感的鲍曼不动杆菌引起。两组患者的死亡率分别为56%（14/25）和35.7%（5/14）（P = 0.22）。二元分析显示，鲍曼不动杆菌菌血症患者中，先前使用氟喹诺酮类药物（P = 0.01）和抗假单胞菌青霉素（P = 0.004）以及菌血症当天使用的抗生素数量较多（P = 0.02）与Co(S)/Ca(R)菌株的分离有关。使用向后逻辑回归模型进行的多变量分析显示，仅使用氟喹诺酮类药物与Co(S)/Ca(R)鲍曼不动杆菌菌血症的发生有关（比值比=11.6；95%置信区间2.4 - 55.9；P = 0.02）。Co(S)/Ca(R)鲍曼不动杆菌感染的出现对住院重症患者构成重大威胁。使用氟喹诺酮类药物是Co(S)/Ca(R)鲍曼不动杆菌菌血症发生的独立危险因素。
