Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Microb Drug Resist. 2011 Jun;17(2):305-12. doi: 10.1089/mdr.2010.0170. Epub 2011 Mar 7.
Despite the high prevalence of antimicrobial resistance among Pseudomonas aeruginosa bacteremia, the clinical consequence of resistance remains unclear. The purpose of this study was to identify predictors of mortality and evaluate the clinical impact of antimicrobial resistance on outcome in P. aeruginosa bacteremia. A retrospective cohort study including patients with P. aeruginosa bacteremia was performed. The risk factors for antimicrobial resistances were evaluated, and the impact of the respective resistances on mortality was assessed. Of 202 P. aeruginosa bacteremia cases, the resistance rates to ceftazidime, piperacillin, imipenem, fluoroquinolone, and aminoglycoside were 36.6%, 22.3%, 22.8%, 23.8%, and 17.8%, respectively. A prior use of fluoroquinolones and an indwelling urinary catheter were common risk factors for all types of antimicrobial resistance. The overall 30-day mortality rate was 25.2% (51/202), and the risk factors for mortality were corticosteroid use, nosocomial acquisition, polymicrobial infection, an increasing Charlson's weighted co-morbidity index, and intensive care unit care (p < 0.05). As compared with the susceptible group, ceftazidime-, piperacillin-, or imipenem-resistant groups had a higher mortality (p < 0.05). A multivariate analysis showed that resistance to ceftazidime or imipenem remained a significant factor associated with mortality (odds ratio, 2.96; 95% confidential interval, 1.20-7.31; and odds ratio, 2.74; 95% confidential interval, 1.02-7.31, respectively). Antimicrobial resistance, especially to ceftazidime or imipenem, adversely affected outcome in patients with P. aeruginosa bacteremia.
尽管铜绿假单胞菌菌血症中存在高比例的抗菌药物耐药性，但耐药性的临床后果仍不清楚。本研究旨在确定死亡率的预测因素，并评估铜绿假单胞菌菌血症中抗菌药物耐药性对预后的临床影响。进行了一项包括铜绿假单胞菌菌血症患者的回顾性队列研究。评估了抗菌药物耐药的危险因素，并评估了各自耐药性对死亡率的影响。在 202 例铜绿假单胞菌菌血症病例中，头孢他啶、哌拉西林、亚胺培南、氟喹诺酮和氨基糖苷类的耐药率分别为 36.6%、22.3%、22.8%、23.8%和 17.8%。氟喹诺酮类药物的先前使用和留置导尿管是所有类型抗菌药物耐药的常见危险因素。总的 30 天死亡率为 25.2%（51/202），死亡的危险因素包括皮质类固醇的使用、医院获得性感染、混合感染、Charlson 加权合并症指数增加和重症监护病房护理（p<0.05）。与敏感组相比，头孢他啶、哌拉西林或亚胺培南耐药组的死亡率更高（p<0.05）。多变量分析显示，对头孢他啶或亚胺培南的耐药性仍然是与死亡率相关的显著因素（比值比，2.96；95%置信区间，1.20-7.31；和比值比，2.74；95%置信区间，1.02-7.31）。抗菌药物耐药性，尤其是对头孢他啶或亚胺培南的耐药性，对铜绿假单胞菌菌血症患者的预后产生了不利影响。
