Kadri Sameer S, Hohmann Samuel F, Orav E John, Bonne Stephanie L, Moffa Matthew A, Timpone Joseph G, Strich Jeffrey R, Palmore Tara, Christopher Kenneth B, Varughese Christy, Hooper David C, Danner Robert L
Critical Care Medicine Department Division of Infectious Diseases.
University HealthSystem Consortium Department of Health Systems Management, Rush University, Chicago, Illinois.
Clin Infect Dis. 2015 Jan 1;60(1):79-87. doi: 10.1093/cid/ciu741. Epub 2014 Sep 22.
Existing surveillance mechanisms may underestimate the incidence of carbapenem-resistant gram-negative infections (CRGNIs). Although carbapenem resistance increases the risk of death, the trend in mortality over time is unknown.
A retrospective cohort study was conducted at 40 academic medical centers using a discharge database to identify adult hospital admissions without cystic fibrosis in 2006-2012 and received intravenous colistin for >3 consecutive days or died during therapy (termed colistin cases). The primary outcomes were the number of colistin cases per 100,000 admissions per year and change in the hospital mortality rate over time compared with the rate of discharges to home. Secondary outcomes included median overall and intensive care unit lengths of stay.
From 2006 to 2012, a total of 5011 unique patients were identified as colistin cases. The number per 100,000 admissions per year increased from 35.56 to 92.98 during the 7-year study (P < .001). The odds of in-hospital death among colistin cases (compared with discharge to home) decreased by a mean of 5.2%/y (P = .04), whereas discharge to an institution (P = .24) or hospice (P = .89) remained steady over time. The median overall and intensive care unit lengths of stay decreased by 7.5 and 6 days, respectively (P < .001). In a 4-hospital chart review, 81.6% of colistin cases were found to have culture-positive CRGNIs. Conversely, 53% of extensively drug-resistant bloodstream CRGNIs at 2 of these hospitals met colistin case criteria.
Colistin cases represent a severely ill population with a high probability of having culture-confirmed CRGNIs. Colistin tracking is a novel strategy for monitoring the incidence and mortality of CRGNIs, particularly those caused by extensively drug-resistant bacteria. Although the incidence of colistin cases nearly tripled within 7 years, more of these patients are surviving hospitalization and going home.
现有的监测机制可能低估了耐碳青霉烯类革兰阴性菌感染（CRGNI）的发病率。尽管碳青霉烯类耐药性增加了死亡风险，但死亡率随时间的变化趋势尚不清楚。
在40家学术医疗中心进行了一项回顾性队列研究，使用出院数据库识别2006 - 2012年无囊性纤维化的成年住院患者，这些患者接受静脉注射多粘菌素连续超过3天或在治疗期间死亡（称为多粘菌素病例）。主要结局是每年每10万例住院患者中的多粘菌素病例数，以及与出院回家率相比随时间变化的医院死亡率。次要结局包括总体和重症监护病房住院时间的中位数。
2006年至2012年，共有5011例独特患者被确定为多粘菌素病例。在7年研究期间，每年每10万例住院患者中的病例数从35.56增加到92.98（P <.001）。多粘菌素病例中院内死亡的几率（与出院回家相比）平均每年下降5.2%（P =.04），而转至机构（P =.24）或临终关怀机构（P =.89）的几率随时间保持稳定。总体和重症监护病房住院时间的中位数分别减少了7.5天和6天（P <.001）。在对4家医院的病历审查中，发现81.6%的多粘菌素病例有培养阳性的CRGNI。相反，这2家医院中53%的广泛耐药血流CRGNI符合多粘菌素病例标准。
多粘菌素病例代表了病重的人群，很可能患有培养确诊的CRGNI。多粘菌素追踪是监测CRGNI发病率和死亡率的一种新策略，特别是那些由广泛耐药细菌引起的感染。尽管多粘菌素病例的发病率在7年内几乎增加了两倍，但更多此类患者在住院后存活并回家。
