Lagnf Abdalhamid M, Zasowski Evan J, Claeys Kimberly C, Casapao Anthony M, Rybak Michael J
Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI.
Anti-Infective Research Laboratory, Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI; Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI; Department of Pharmacy Services, Detroit Medical Center, Detroit, MI.
Am J Infect Control. 2016 Aug 1;44(8):917-21. doi: 10.1016/j.ajic.2016.02.017. Epub 2016 Apr 11.
Enterococcal bloodstream infections (EBSIs) are frequently polymicrobial but scant data describe the outcomes and risk factors of polymicrobial EBSI. This study describes the outcomes and risk factors of polymicrobial versus monomicrobial EBSI.
In this single-center, retrospective, matched cohort study, patients with polymicrobial EBSI were matched 1:1 to patients with monomicrobial EBSI by age ± 10 years, EBSI source, Pitt bacteremia score, and enterococcal species. Conditional logistic regression was performed to determine independent predictors of 30-day mortality and polymicrobial EBSI.
In 142 matched pairs, 30-day mortality was 18.3% versus 21.1% (P = .551) in monomicrobial and polymicrobial EBSI, respectively. In multivariable analysis, recent chemotherapy/radiation (adjusted odds ratio [OR], 4.799; 95% confidence interval [CI], 1.814-12.696), chronic renal disease (aOR, 2.310; 95% CI, 1.176-4.539), and Pitt bacteremia score (aOR, 1.399; 95% CI, 1.147-1.706) were associated with 30-day mortality. Recent chemotherapy/radiation (aOR, 2.770; 95% CI, 1.016-7.551), and recent antibiotic exposure (aOR, 1.892; 95% CI, 1.157-3.092) were positively associated with polymicrobial EBSI, whereas chronic hemodialysis was negatively associated (aOR, 0.496; 95% CI, 0.29-81).
Overall, polymicrobial EBSI were not independently associated with mortality. Risk factors for, and the clinical implications of, polymicrobial EBSI should be further studied to inform clinical management and improve outcomes.
肠球菌血流感染（EBSIs）通常是多微生物感染，但关于多微生物EBSI的结局和危险因素的数据很少。本研究描述了多微生物与单微生物EBSI的结局和危险因素。
在这项单中心、回顾性、匹配队列研究中，根据年龄±10岁、EBSI来源、皮特菌血症评分和肠球菌种类，将多微生物EBSI患者与单微生物EBSI患者按1:1进行匹配。采用条件逻辑回归分析确定30天死亡率和多微生物EBSI的独立预测因素。
在142对匹配病例中，单微生物和多微生物EBSI的30天死亡率分别为18.3%和21.1%（P = 0.551）。在多变量分析中，近期化疗/放疗（调整优势比[OR]，4.799；95%置信区间[CI]，1.814 - 12.696）、慢性肾病（aOR，2.310；95% CI，1.176 - 4.539）和皮特菌血症评分（aOR，1.399；95% CI，1.147 - 1.706）与30天死亡率相关。近期化疗/放疗（aOR，2.770；95% CI，1.016 - 7.551）和近期抗生素暴露（aOR，1.892；95% CI，1.157 - 3.092）与多微生物EBSI呈正相关，而慢性血液透析与之呈负相关（aOR，0.496；95% CI，0.29 - 81）。
总体而言，多微生物EBSI与死亡率无独立相关性。多微生物EBSI的危险因素及其临床意义应进一步研究，以指导临床管理并改善预后。
