Tang C Q, Li J Q, Xia Z F, Wang H, Lü K Y, Xiao S C, Deng A M, Huang Y
Department of Burn, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
Zhonghua Yi Xue Za Zhi. 2016 Jul 12;96(26):2076-80. doi: 10.3760/cma.j.issn.0376-2491.2016.26.008.
To compare the clinical outcomes and costs associated with carbapenems and β-lactam/β-lactamase inhibitor combinations (BLBLIs) for the empirical treatment of patients with extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae bloodstream infections (BSIs).
The medical records of individuals diagnosed with ESBL-producing Escherichia coli and Klebsiella pneumoniae BSIs between January 2014 and June 2015 at Changhai Hospital were reviewed. Patients were divided into two groups based on the empirical therapy (carbapenems group and BLBLIs group). Propensity score matching in a 1∶1 ratio was used to match the patients from two groups. Clinical outcomes and costs were compared before and after matching.
One hundred and fifty-eight patients were analyzed, 93 in the carbapenems group and 65 in the BLBLIs group. Before matching, the two groups were significantly different in department distribution, tumor rate, deep vein catheter rate, urinary catheter rate, nasogastric tube rate, and mechanical ventilation rate (all P<0.05), and the carbapenems group had longer total length of stay (LOS) and post-BSI LOS (26.0 vs 18.0 d, P=0.029 and 12.0 vs 10.0 d, P=0.044) , higher hospital cost and daily hospital cost (84 120 vs 39 000 ￥, P<0.001 and 3 451 vs 2 574 ￥, P=0.002). After matching, the two groups had no significant differences in covariates such as sex, age, department distribution, pathogens, comorbidities, invasive interventions, LOS before BSI, multiple admissions, surgical rate during hospitalization and delayed antimicrobial therapy (all P>0.05). Finally, there were no differences between two groups in mortality, post-BSI LOS, total LOS, hospital cost and antimicrobial cost (all P>0.05).
BLBLIs may provide a reasonable carbapenem-sparing option for the empirical treatment of ESBL producers.
比较碳青霉烯类药物与β-内酰胺类/β-内酰胺酶抑制剂合剂（BLBLIs）用于经验性治疗产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌血流感染（BSIs）患者的临床疗效和成本。
回顾性分析2014年1月至2015年6月在长海医院诊断为产ESBL大肠埃希菌和肺炎克雷伯菌血流感染患者的病历。根据经验性治疗方案将患者分为两组（碳青霉烯类药物组和BLBLIs组）。采用1∶1倾向评分匹配法对两组患者进行匹配。比较匹配前后的临床疗效和成本。
共分析158例患者，碳青霉烯类药物组93例，BLBLIs组65例。匹配前，两组在科室分布、肿瘤发生率、深静脉导管使用率、导尿管使用率、鼻胃管使用率和机械通气使用率方面存在显著差异（均P<0.05），碳青霉烯类药物组的总住院时间（LOS）和BSI后住院时间更长（26.0 d对18.0 d，P=0.029；12.0 d对10.0 d，P=0.044），住院费用和每日住院费用更高（84 120元对39 000元，P<0.001；3 451元对2 574元，P=0.002）。匹配后，两组在性别、年龄、科室分布、病原体、合并症、侵入性操作、BSI前住院时间、多次入院、住院期间手术率和延迟抗菌治疗等协变量方面无显著差异（均P>0.05）。最后，两组在死亡率、BSI后住院时间、总住院时间、住院费用和抗菌药物费用方面无差异（均P>0.05）。
BLBLIs可为产ESBL菌的经验性治疗提供一种合理的碳青霉烯类药物替代选择。
