Perianes-Díaz María Electra, Novo-Veleiro Ignacio, Solís-Díaz Katia, Prolo-Acosta Andrea, García-García Inmaculada, Alonso-Claudio Gloria
Servicio de Medicina Interna, Hospital Universitario de Salamanca, Salamanca, España.
Servicio de Medicina Interna, Hospital Universitario de Salamanca, Salamanca, España.
Med Clin (Barc). 2014 May 6;142(9):381-6. doi: 10.1016/j.medcli.2013.01.048. Epub 2013 Jun 2.
The incidence of bloodstream-infections caused by extended-spectrum betalactamases (ESBL)-producing bacteria has increased exponentially. The objective of this study is to determine the factors related to mortality and readmission in these patients.
Socio-epidemiological, clinical and laboratory data has been collected (from January, 1st 2008 to April, 31th 2011). They were classified as nosocomial, healthcare-associated or community-acquired data. A descriptive research was conducted to determine the main differences in terms of responsible bacteria and variables associated with mortality and readmission rates. The following techniques were used to compare variables: Student's t-test, one-way ANOVA test, χ(2)-test and Fisher's exact test. A logistic-regression analysis was performed to identify variables independently related to mortality and readmission, using SPSS(®) statistics software v18.
A total of 68 patients were included in the study: 73.5% of the infections were caused by Escherichia coli (E. coli), and 26.5% by Klebsiella pneumoniae (K. pneumoniae). Nosocomial origin, critical condition of patients, and abdominal location were more frequent when K. pneumoniae was isolated; urinary tract was the most frequent site of E. coli infections. The in-hospital mortality reached 20.6%, and 24% during the follow-up period. The main factor associated to in-hospital mortality was previous antibiotic treatment (OR 8.37; CI 95%: 1.094-64.091); within the follow-up period, the first mortality factor was central venous catheterization (OR 8.416; CI 95%: 1.367-51.821). Readmission was required in 55.5% of patients. The main variables associated were nosocomial origin (OR 4.801; CI 95%: 1.057-21.802) and previous antibiotic treatment (OR 4.715; CI 95%: 1.125-19.766). Inadequate antibiotic treatment was not associated with increased mortality or readmission. Conclusions ESBL-producing E. coli and K. pneumoniae bloodstream-infections are linked to a high mortality and readmission risk. Previous antibiotic treatment is the main factor associated to a poor outcome.
产超广谱β-内酰胺酶（ESBL）细菌引起的血流感染发病率呈指数级增长。本研究的目的是确定这些患者中与死亡率和再入院相关的因素。
收集了社会流行病学、临床和实验室数据（从2008年1月1日至2011年4月31日）。这些数据被分类为医院感染、医疗保健相关感染或社区获得性感染数据。进行了一项描述性研究，以确定在致病细菌以及与死亡率和再入院率相关的变量方面的主要差异。使用以下技术比较变量：学生t检验、单因素方差分析、χ²检验和Fisher精确检验。使用SPSS®统计软件v18进行逻辑回归分析，以确定与死亡率和再入院独立相关的变量。
本研究共纳入68例患者：73.5%的感染由大肠杆菌（E. coli）引起，26.5%由肺炎克雷伯菌（K. pneumoniae）引起。分离出肺炎克雷伯菌时，医院感染来源、患者的危急状况和腹部感染部位更为常见；泌尿道是大肠杆菌感染最常见的部位。住院死亡率达到20.6%，随访期间为24%。与住院死亡率相关的主要因素是先前的抗生素治疗（比值比8.37；95%置信区间：1.094 - 64.091）；在随访期间，首要的死亡因素是中心静脉置管（比值比8.416；95%置信区间：1.367 - 51.821）。55.5%的患者需要再次入院。相关的主要变量是医院感染来源（比值比4.801；95%置信区间：1.057 - 21.802）和先前的抗生素治疗（比值比4.715；95%置信区间：1.125 - 19.766）。抗生素治疗不当与死亡率或再入院率增加无关。结论：产ESBL的大肠杆菌和肺炎克雷伯菌血流感染与高死亡率和再入院风险相关。先前的抗生素治疗是与不良结局相关的主要因素。
