Brady M, Oza A, Cunney R, Burns K
Health Protection Surveillance Centre, Dublin, Ireland; Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.
Health Protection Surveillance Centre, Dublin, Ireland.
J Hosp Infect. 2017 May;96(1):35-41. doi: 10.1016/j.jhin.2017.02.006. Epub 2017 Feb 9.
To estimate the attributable mortality of hospital-acquired bloodstream infections (HA-BSI) in Ireland.
A retrospective case-cohort study was conducted, based on notifications from Irish microbiology laboratories and administrative patient records from six Irish hospitals from January 2007 to December 2013. Probabilistic linkage was used to link 1252 cases of bloodstream infection from a cohort of 343,189 hospitalized patients. Independent predictors of mortality were determined using a multi-variable logistic regression model, and included: patient age, emergency or re-admission to hospital, length of stay in an intensive care unit, number of procedures, number of diagnoses, major diagnostic category and presence of HA-BSI.
Attributable mortality was calculated from the crude mortality of case subjects after adjusting for other predictors of mortality, and was found to be 15.3% (95% confidence interval 14.8-15.8%). The study was further stratified according to the causative organism, including: Escherichia coli, Enterococcus faecium, Enterococcus faecalis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Streptococcus pneumoniae, and, where available, their antimicrobial resistance patterns. The highest attributable mortality among these organisms was reported for E. faecium at 18.1% and the lowest attributable mortality was reported for E. coli at 13.6%. A significantly higher attributable mortality was found for antimicrobial resistance patterns of some organisms, most notably for meticillin-resistant S. aureus at 19.5%, vs meticillin-susceptible S. aureus at 13.3%.
HA-BSI is an important cause of mortality, and attributable mortality differs significantly among causative organisms and antimicrobial resistance patterns.
评估爱尔兰医院获得性血流感染（HA-BSI）的归因死亡率。
进行了一项回顾性病例队列研究，数据来源于爱尔兰微生物实验室的报告以及2007年1月至2013年12月期间爱尔兰六家医院的患者管理记录。采用概率性链接方法，将来自343,189名住院患者队列中的1252例血流感染病例进行链接。使用多变量逻辑回归模型确定死亡率的独立预测因素，包括：患者年龄、急诊或再次入院、重症监护病房住院时间、手术数量、诊断数量、主要诊断类别以及是否存在HA-BSI。
在对其他死亡率预测因素进行调整后，根据病例组的粗死亡率计算出归因死亡率为15.3%（95%置信区间14.8-15.8%）。该研究进一步根据病原体进行分层，包括：大肠杆菌、粪肠球菌、屎肠球菌、铜绿假单胞菌、肺炎克雷伯菌、金黄色葡萄球菌和肺炎链球菌，以及在可行情况下它们的抗菌药物耐药模式。这些病原体中，屎肠球菌的归因死亡率最高，为18.1%，大肠杆菌的归因死亡率最低，为13.6%。发现某些病原体的抗菌药物耐药模式的归因死亡率显著更高，最明显的是耐甲氧西林金黄色葡萄球菌为19.5%，而甲氧西林敏感金黄色葡萄球菌为13.3%。
HA-BSI是导致死亡的重要原因，不同病原体和抗菌药物耐药模式的归因死亡率存在显著差异。
