Thaden Joshua T, Park Lawrence P, Maskarinec Stacey A, Ruffin Felicia, Fowler Vance G, van Duin David
Duke University Division of Infectious Diseases, Durham, North Carolina, USA.
Duke University Division of Infectious Diseases, Durham, North Carolina, USA
Antimicrob Agents Chemother. 2017 May 24;61(6). doi: 10.1128/AAC.02671-16. Print 2017 Jun.
The impact of bacterial species on outcome in bloodstream infections (BSI) is incompletely understood. We evaluated the impact of bacterial species on BSI mortality, with adjustment for patient, bacterial, and treatment factors. From 2002 to 2015, all adult inpatients with monomicrobial BSI caused by or Gram-negative bacteria at Duke University Medical Center were prospectively enrolled. Kaplan-Meier curves and multivariable Cox regression with propensity score models were used to examine species-specific bacterial BSI mortality. Of the 2,659 enrolled patients, 999 (38%) were infected with , and 1,660 (62%) were infected with Gram-negative bacteria. Among patients with Gram-negative BSI, (81% [1,343/1,660]) were most commonly isolated, followed by non-lactose-fermenting Gram-negative bacteria (16% [262/1,660]). Of the 999 BSI isolates, 507 (51%) were methicillin resistant. Of the 1,660 Gram-negative BSI isolates, 500 (30%) were multidrug resistant. The unadjusted time-to-mortality among patients with Gram-negative BSI was shorter than that of patients with BSI ( = 0.003), due to increased mortality in patients with non-lactose-fermenting Gram-negative BSI generally ( < 0.0001) and BSI ( = 158) in particular ( < 0.0001). After adjustment for patient demographics, medical comorbidities, bacterial antibiotic resistance, timing of appropriate antibiotic therapy, and source control in patients with line-associated BSI, BSI remained significantly associated with increased mortality (hazard ratio = 1.435; 95% confidence interval = 1.043 to 1.933; = 0.02). BSI was associated with increased mortality relative to or other Gram-negative BSI. This effect persisted after adjustment for patient, bacterial, and treatment factors.
细菌种类对血流感染(BSI)结局的影响尚未完全明确。我们评估了细菌种类对BSI死亡率的影响,并对患者、细菌和治疗因素进行了校正。2002年至2015年,杜克大学医学中心所有由革兰氏阳性或革兰氏阴性细菌引起的成年单微生物BSI住院患者均被前瞻性纳入研究。采用Kaplan-Meier曲线和倾向评分模型的多变量Cox回归分析特定细菌种类的BSI死亡率。在纳入的2659例患者中,999例(38%)感染革兰氏阳性菌,1660例(62%)感染革兰氏阴性菌。在革兰氏阴性菌BSI患者中,大肠杆菌(81%[1343/1660])最常被分离出来,其次是非发酵革兰氏阴性菌(16%[262/1660])。在999例革兰氏阳性菌BSI分离株中,507例(51%)对甲氧西林耐药。在1660例革兰氏阴性菌BSI分离株中,500例(30%)对多种药物耐药。革兰氏阴性菌BSI患者未经校正的死亡时间短于革兰氏阳性菌BSI患者(P = 0.003),这是由于非发酵革兰氏阴性菌BSI患者总体死亡率增加(P < 0.0001),尤其是大肠杆菌BSI患者(P = 0.0001)。在对患者人口统计学、合并症、细菌抗生素耐药性、适当抗生素治疗时机以及导管相关BSI患者的源头控制进行校正后,革兰氏阳性菌BSI仍与死亡率增加显著相关(风险比 = 1.435;95%置信区间 = 1.043至1.933;P = 0.02)。与大肠杆菌或其他革兰氏阴性菌BSI相比,革兰氏阳性菌BSI与死亡率增加相关。在对患者、细菌和治疗因素进行校正后,这种影响仍然存在。