鲍曼不动杆菌感染中碳青霉烯类耐药的临床及流行病学意义
Clinical and Epidemiological Significance of Carbapenem Resistance in Acinetobacter baumannii Infections.
作者信息
Tal-Jasper Ruthy, Katz David E, Amrami Nadav, Ravid Dor, Avivi Dori, Zaidenstein Ronit, Lazarovitch Tsilia, Dadon Mor, Kaye Keith S, Marchaim Dror
机构信息
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Internal Medicine D, Shaare Zedek Medical Center, Jerusalem, Israel.
出版信息
Antimicrob Agents Chemother. 2016 Apr 22;60(5):3127-31. doi: 10.1128/AAC.02656-15. Print 2016 May.
Abstract
Carbapenems are considered the treatment of choice for Acinetobacter baumannii infections. Many facilities implement preventive measures toward only carbapenem-resistant A. baumannii (CRAB). However, the independent role of the carbapenem resistance determinant on patient outcomes remains controversial. In a 6-year analysis of adults with A. baumannii bloodstream infection (BSI), the outcomes of 149 CRAB isolates were compared to those of 91 patients with carbapenem-susceptible A. baumannii In bivariable analyses, CRAB BSIs were significantly associated with worse outcomes and with a delay in the initiation of appropriate antimicrobial therapy (DAAT). However, in multivariable analyses, carbapenem resistance status was no longer associated with poor outcomes, while DAAT remained an independent predictor. The epidemiological significance of A. baumannii should not be determined by its resistance to carbapenems.
摘要
碳青霉烯类药物被认为是治疗鲍曼不动杆菌感染的首选药物。许多医疗机构仅针对耐碳青霉烯鲍曼不动杆菌（CRAB）采取预防措施。然而，碳青霉烯耐药决定因素对患者预后的独立作用仍存在争议。在一项对成人鲍曼不动杆菌血流感染（BSI）的6年分析中，将149株CRAB分离株的预后与91例对碳青霉烯敏感的鲍曼不动杆菌患者的预后进行了比较。在双变量分析中，CRAB BSI与较差的预后以及适当抗菌治疗起始延迟（DAAT）显著相关。然而，在多变量分析中，碳青霉烯耐药状态不再与不良预后相关，而DAAT仍然是一个独立的预测因素。鲍曼不动杆菌的流行病学意义不应由其对碳青霉烯类药物的耐药性来决定。
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