Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
Clin Infect Dis. 2012 Jul;55(2):209-15. doi: 10.1093/cid/cis385. Epub 2012 Apr 11.
The efficacy of antimicrobial therapy for Acinetobacter baumannii bacteremia has been difficult to establish because of confounding by underlying diseases, severity of infection, and differences in the pathogenicity of Acinetobacter species. This retrospective study was conducted to evaluate the effect of appropriate antimicrobial therapy on 14-day mortality after adjustment for multiple risk factors.
The population consisted of 252 patients with monomicrobial A. baumannii bacteremia admitted to a large teaching hospital in Taiwan. The isolates were identified to species level using reference molecular methods. Predictors of 14-day mortality were determined by logistic regression analysis. The influence of severity of infection, determined by Acute Physiology and Chronic Health Evaluation (APACHE) II score, on the impact of appropriate use of antimicrobials on 14-day mortality was assessed by including an interaction term.
The overall 14-day mortality rate was 29.8% (75 of 252 patients). The unadjusted mortality rate for appropriate antimicrobial therapy was 13.2% (12 of 91 patients). Appropriate therapy was independently associated with reduced mortality (odds ratio [OR], 0.22; 95% confidence interval [CI], .01-.50; P < .001), and the effect was influenced by APACHE II score (OR for interaction term, 0.90; 95% CI, .82-.98; P= .02). A subgroup analysis revealed that the benefit of appropriate therapy was limited to patients with high APACHE II scores (OR for patients with scores >25 and ≤ 35, 0.16 [95% CI, .07-.37]; OR for those with scores >35, 0.06; 95% CI, .01-.25).
Appropriate antimicrobial therapy significantly reduced 14-day mortality for A. baumannii bacteremia in severely ill patients.
由于基础疾病、感染严重程度和不动杆菌种致病性的差异，抗菌治疗对鲍曼不动杆菌菌血症的疗效一直难以确定。本回顾性研究旨在评估在调整多种危险因素后，适当抗菌治疗对 14 天死亡率的影响。
本研究纳入了台湾一家大型教学医院的 252 例单一致病菌血症患者。采用参考分子方法对分离株进行种水平鉴定。通过 logistic 回归分析确定 14 天死亡率的预测因素。通过纳入交互项，评估感染严重程度（通过急性生理学和慢性健康评估（APACHE）II 评分确定）对适当使用抗菌药物对 14 天死亡率的影响。
总的 14 天死亡率为 29.8%（252 例患者中有 75 例）。适当抗菌治疗的未调整死亡率为 13.2%（91 例患者中有 12 例）。适当的治疗与降低死亡率独立相关（优势比 [OR]，0.22；95%置信区间 [CI]，0.01-0.50；P < 0.001），且该效应受 APACHE II 评分的影响（交互项的 OR，0.90；95%CI，0.82-0.98；P = 0.02）。亚组分析显示，适当治疗的获益仅限于 APACHE II 评分较高的患者（评分>25 且≤35 的患者的 OR，0.16[95%CI，0.07-0.37]；评分>35 的患者的 OR，0.06；95%CI，0.01-0.25）。
在重症患者中，适当的抗菌治疗可显著降低鲍曼不动杆菌菌血症的 14 天死亡率。
