College of Pharmacy, University of Minnesota, 308 Harvard St. 1 SE, Minneapolis, MN 55455-0343, USA.
Surg Infect (Larchmt). 2010 Feb;11(1):33-9. doi: 10.1089/sur.2008.076.
Inadequate antibiotic therapy and failure to administer antibiotics in a timely fashion have been associated with substantial mortality rates in patients in the intensive care unit (ICU). We analyzed the infection pattern in solid organ transplant recipients as well as the impact of antibiotic resistance and inadequate antibiotic treatment on mortality rates and morbidity outcomes.
Charts of adult solid organ transplant recipients in 2006 from a single institution were reviewed. Data on patients with bacterial and fungal infections acquired within one year after transplantation were compared with the primary outcome of death within 28 days. Statistical analysis included nonparametric tests (Wilcoxon rank sum, Fisher exact, and chi-square) and multivariable logistic regression with p < 0.05 considered significant.
Of the 366 patients, 114 (31%) had a total of 208 bacterial or fungal infections, and 44 of them (39%) were admitted to the ICU. Our primary endpoint, the 28-day mortality rate, was 8% overall, whereas the six-month mortality rate was 11%. Patients treated inadequately with antibiotics had a significantly higher mortality rate. The leading causes of infection were multiple organisms, coagulase-negative Staphylococcus, and E. coli, of which 76% were resistant to antibiotics. Antibiotic-resistant infections were associated with longer hospital stays (p = 0.04), intravenous antibiotic use prior to infection (p = 0.04), nucleotide synthesis inhibitor use (p = 0.02), ICU admission (p < 0.01), and respiratory failure (p = 0.03). Most infections were treated inadequately initially (69%) but treated adequately at 24 h (56%). Inadequate antibiotic treatment was significantly associated with younger age (p = 0.04), prior intravenous antibiotic use (p = 0.04), longer stay prior to infection (p = 0.05), and cardiovascular shock (p = 0.014). Inadequate antibiotic therapy at 24 h was associated with a higher mortality rate (14% vs. 2%; p = 0.03) and a trend toward longer ICU and in-hospital stays.
Most bacterial and fungal infections were resistant to antibiotics and were treated inadequately initially. Prior intravenous antibiotic use and longer stay prior to infection were associated with antibiotic resistance and inadequate antibiotic therapy. Failure to provide adequate antibiotic treatment within 24 h had a significant impact on the 28-day mortality rate and was associated with other detrimental clinical outcomes.
在重症监护病房（ICU）的患者中，抗生素治疗不足和未能及时给予抗生素与死亡率显著相关。我们分析了实体器官移植受者的感染模式，以及抗生素耐药性和抗生素治疗不足对死亡率和发病率结果的影响。
回顾了 2006 年来自一家机构的成年实体器官移植受者的图表。比较了 1 年内获得的细菌和真菌感染患者的数据，与 28 天内死亡的主要结局。统计分析包括非参数检验（Wilcoxon 秩和、Fisher 确切检验和卡方检验）和多变量逻辑回归，p<0.05 被认为有统计学意义。
在 366 名患者中，114 名（31%）有总计 208 例细菌或真菌感染，其中 44 名（39%）入住 ICU。我们的主要终点，28 天死亡率为 8%，6 个月死亡率为 11%。抗生素治疗不足的患者死亡率明显更高。感染的主要原因是多种病原体、凝固酶阴性葡萄球菌和大肠杆菌，其中 76%对抗生素耐药。抗生素耐药感染与住院时间延长（p=0.04）、感染前静脉用抗生素（p=0.04）、核苷酸合成抑制剂使用（p=0.02）、入住 ICU（p<0.01）和呼吸衰竭（p=0.03）相关。大多数感染最初治疗不足（69%），但在 24 小时内治疗适当（56%）。抗生素治疗不足与年龄较小（p=0.04）、感染前静脉用抗生素（p=0.04）、感染前住院时间较长（p=0.05）和心血管休克（p=0.014）显著相关。24 小时内抗生素治疗不足与死亡率较高（14%对 2%；p=0.03）和 ICU 住院时间和住院时间延长有关。
大多数细菌和真菌感染对抗生素耐药，最初治疗不足。感染前静脉用抗生素和感染前住院时间较长与抗生素耐药和抗生素治疗不足有关。未能在 24 小时内提供足够的抗生素治疗对 28 天死亡率有显著影响，并与其他不良临床结果相关。
