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规范的传染性疾病会诊可降低金黄色葡萄球菌菌血症的死亡率。

Formal infectious diseases consultation is associated with decreased mortality in Staphylococcus aureus bacteraemia.

机构信息

Department of Microbiology and Infectious Diseases, PathWest Laboratory Medicine Royal Perth Hospital, Wellington Street, Perth, 6000, Western Australia, Australia.

出版信息

Eur J Clin Microbiol Infect Dis. 2012 Sep;31(9):2421-8. doi: 10.1007/s10096-012-1585-y. Epub 2012 Mar 3.

Abstract

To determine the impact of infectious diseases consultation (IDC) in Staphylococcus aureus bacteraemia. All MRSA bacteraemia and a random subset of MSSA bacteraemia were retrospectively analysed. Out of 599 SAB episodes, 162 (27%) were followed by an IDC. Patients with IDC were younger and more frequently intravenous drug users, but fewer resided in a long-term care facility or were indigenous. Hospital length of stay was longer (29.5 vs 17 days, p < 0.001), and endocarditis (19.1% vs 7.3%, p < 0.001) and metastatic seeding (22.2% vs 10.1%, p < 0.001) were more frequent in the IDC group; however, SAPS II scores were lower in the IDC group (27 vs 37, p < 0.001). ICU admission rates in the two groups were similar. The isolate tested susceptible to empirical therapy more frequently in the IDC group (88.9% vs 78.0%, p = 0.003). Seven-day (3.1 vs 16.5%), 30-day (8.0% vs 27.0%) and 1-year mortality (22.2% vs 44.9%) were all lower in the IDC group (all p < 0.001). Multivariate analysis showed that effective initial therapy was the only variable associated with the protective effect of IDC. In patients with SAB, all-cause mortality was significantly lower in patients who had an IDC, because of the higher proportion of patients receiving effective initial antibiotics.

摘要

为了确定传染病咨询(IDC)对金黄色葡萄球菌菌血症的影响。回顾性分析了所有耐甲氧西林金黄色葡萄球菌菌血症(MRSA)和随机选择的部分甲氧西林敏感金黄色葡萄球菌菌血症(MSSA)。在 599 例 SAB 发作中,有 162 例(27%)随后进行了 IDC。接受 IDC 的患者更年轻,且更常为静脉药物使用者,但居住在长期护理机构或土著居民的比例较低。住院时间更长(29.5 天与 17 天,p<0.001),ID C 组的心内膜炎(19.1%与 7.3%,p<0.001)和转移性播散(22.2%与 10.1%,p<0.001)更为常见,但 IDC 组 SAPS II 评分较低(27 分与 37 分,p<0.001)。两组 ICU 入院率相似。ID C 组的分离株对经验性治疗更敏感(88.9%与 78.0%,p=0.003)。7 天(3.1%与 16.5%)、30 天(8.0%与 27.0%)和 1 年死亡率(22.2%与 44.9%)均在 ID C 组较低(均 p<0.001)。多变量分析表明,有效初始治疗是 ID C 保护作用的唯一相关变量。在 SAB 患者中,ID C 患者的全因死亡率明显较低,因为接受有效初始抗生素治疗的患者比例更高。

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