Centre for Infectious Disease Control, National Institute for Public Health and the Environment, RIVM, Bilthoven, The Netherlands.
J Antimicrob Chemother. 2011 Feb;66(2):398-407. doi: 10.1093/jac/dkq412. Epub 2010 Nov 23.
This study determined excess mortality and length of hospital stay (LOS) attributable to bloodstream infection (BSI) caused by third-generation-cephalosporin-resistant Escherichia coli in Europe.
A prospective parallel matched cohort design was used. Cohort I consisted of patients with third-generation-cephalosporin-resistant E. coli BSI (REC) and cohort II consisted of patients with third-generation-cephalosporin-susceptible E. coli BSI (SEC). Patients in both cohorts were matched for LOS before infection with patients free of the respective BSI. Thirteen European tertiary care centres participated between July 2007 and June 2008.
Cohort I consisted of 111 REC patients and 204 controls and cohort II consisted of 1110 SEC patients and 2084 controls. REC patients had a higher mortality at 30 days (adjusted odds ratio = 4.6) and a higher hospital mortality (adjusted hazard ratio = 5.7) than their controls. LOS was increased by 8 days. For SEC patients, these figures were adjusted odds ratio = 1.9, adjusted hazard ratio = 2.0 and excess LOS = 3 days. A 2.5 times [95% confidence interval (95% CI) 0.9-6.8] increase in all-cause mortality at 30 days and a 2.9 times (95% CI 1.2-6.9) increase in mortality during entire hospital stay as well as an excess LOS of 5 days (95% CI 0.4-10.2) could be attributed to resistance to third-generation cephalosporins in E. coli BSI.
Morbidity and mortality attributable to third-generation-cephalosporin-resistant E. coli BSI is significant. If prevailing resistance trends continue, high societal and economic costs can be expected. Better management of infections caused by resistant E. coli is becoming essential.
本研究旨在确定欧洲由第三代头孢菌素耐药大肠杆菌引起的血流感染（BSI）导致的超额死亡率和住院时间（LOS）。
采用前瞻性平行匹配队列设计。队列 I 由第三代头孢菌素耐药大肠杆菌血流感染（REC）患者组成，队列 II 由第三代头孢菌素敏感大肠杆菌血流感染（SEC）患者组成。两组患者均在感染前根据 LOS 与未感染相应 BSI 的患者进行匹配。13 家欧洲三级保健中心于 2007 年 7 月至 2008 年 6 月期间参与了研究。
队列 I 包括 111 例 REC 患者和 204 例对照，队列 II 包括 1110 例 SEC 患者和 2084 例对照。REC 患者在 30 天时的死亡率更高（调整后的优势比=4.6），院内死亡率更高（调整后的危险比=5.7）。LOS 增加了 8 天。对于 SEC 患者，这些数字为调整后的优势比=1.9，调整后的危险比=2.0 和超额 LOS=3 天。在 30 天时全因死亡率增加了 2.5 倍（95%可信区间[95%CI]0.9-6.8），整个住院期间死亡率增加了 2.9 倍（95%CI 1.2-6.9），LOS 增加了 5 天（95%CI 0.4-10.2），这些可归因于大肠杆菌 BSI 对第三代头孢菌素的耐药性。
由第三代头孢菌素耐药大肠杆菌 BSI 引起的发病率和死亡率很高。如果流行的耐药趋势继续下去，预计会产生高昂的社会和经济成本。更好地管理耐药大肠杆菌引起的感染变得至关重要。
