Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Clin Microbiol Infect. 2013 Jul;19(7):634-9. doi: 10.1111/j.1469-0691.2012.03967.x. Epub 2012 Jul 10.
Appropriate antimicrobial therapy is effective for severe infections caused by Acinetobacter baumannii, but efficacy for other Acinetobacter species remains to be established. The current study was designed to determine whether appropriate antimicrobial therapy reduces the mortality of patients with Acinetobacter nosocomialis bacteraemia. A 9-year retrospective study of 266 patients with monomicrobial A. nosocomialis bacteraemia was conducted at a large teaching hospital in Taiwan. Multivariable analysis was performed to evaluate the impact on 14-day mortality according to clinical characteristics, severity of disease and use of appropriate antimicrobial therapy. The influence of APACHE II score on the impact of appropriate antimicrobial therapy was analysed by including an interaction term. The overall 14-day mortality was 9.4%. Multivariable analysis revealed that APACHE II score was the only factor significantly associated with mortality (odds ratio, 1.18; 95% confidence interval, 1.11-1.25; p <0.001). Appropriate antimicrobial therapy was not associated with reduced mortality regardless of disease severity. In the subgroup analyses in patients with different clinical conditions, APACHE II score was consistently an independent factor for 14-day mortality, and appropriate antimicrobial therapy did not affect the mortality in any group. In conclusion, severity of disease, based on the APACHE II score, was the independent risk factor for 14-day mortality for patients with monomicrobial A. nosocomialis bacteraemia, even in different clinical conditions. In contrast, appropriate antimicrobial therapy did not reduce the 14-day mortality. The result highlighted a different effect of appropriate antimicrobial therapy on infections caused by two phenotypically undifferentiated Acinetobacter.
适当的抗菌治疗对鲍曼不动杆菌引起的严重感染是有效的，但对其他不动杆菌种的疗效仍有待确定。本研究旨在确定适当的抗菌治疗是否降低了医院获得性不动杆菌血症患者的死亡率。在台湾的一家大型教学医院进行了一项针对 266 例单一致病菌医院获得性不动杆菌血症患者的 9 年回顾性研究。采用多变量分析评估了临床特征、疾病严重程度和适当抗菌治疗对 14 天死亡率的影响。通过包含交互项来分析 APACHE II 评分对适当抗菌治疗影响的影响。总的 14 天死亡率为 9.4%。多变量分析显示，APACHE II 评分是唯一与死亡率显著相关的因素（比值比，1.18；95%置信区间，1.11-1.25；p<0.001）。无论疾病严重程度如何，适当的抗菌治疗与死亡率降低无关。在不同临床情况下的亚组分析中，APACHE II 评分始终是 14 天死亡率的独立因素，适当的抗菌治疗在任何组中都没有影响死亡率。总之，基于 APACHE II 评分的疾病严重程度是单一致病菌医院获得性不动杆菌血症患者 14 天死亡率的独立危险因素，即使在不同的临床情况下也是如此。相比之下，适当的抗菌治疗并不能降低 14 天的死亡率。结果突出了适当的抗菌治疗对两种表型上无差别的不动杆菌感染的不同影响。
