凝固酶阴性葡萄球菌菌血症 30 天住院死亡率相关的预后因素：万古霉素最小抑菌浓度无影响。
Prognostic factors associated with 30-day in-hospital mortality in coagulase-negative Staphylococcus bacteraemia: no impact of vancomycin minimum inhibitory concentration.
机构信息
a Department of Internal Medicine, Infectious Diseases, and Clinical Immunology , Reims Teaching Hospitals, Robert Debré Hospital , Reims , France.
b EA 3797, Faculty of Medicine , University of Reims Champagne-Ardenne , Reims , France.
出版信息
Infect Dis (Lond). 2017 Sep;49(9):664-673. doi: 10.1080/23744235.2017.1323346. Epub 2017 May 11.
BACKGROUND
The impact of a minimum inhibitory concentration (MIC) of vancomycin ≥2 mg/L on mortality and the potential benefit of new antistaphylococcal treatments in coagulase-negative Staphylococcus (CoNS) bacteraemia remain unknown. We assessed the impact of vancomycin MIC on 30-day in-hospital mortality and identified factors independently associated with 30-day in-hospital mortality.
METHODS
All patients presenting significant CoNS bacteraemia in the university hospital of Reims, between 01 January 2008 and 31 December 2012, were included. Data were retrospectively extracted from the patient records. Vancomycin MIC was assessed using the E-test method, and antimicrobial susceptibility testing was performed in accordance with the recommendations of the Antibiogram Committee of the French Microbiology Society. Cox's Proportional Hazards model was used for multivariate analysis.
RESULTS
Two hundred and sixty-nine patients (mean age 61.2 ± 15.7 years) were included. Foreign material was present in 92% of patients and 78.4% of isolated methicillin-resistant strains had vancomycin MIC ≥2 mg/l. Thirty-day in-hospital mortality was 16%. There was no association between vancomycin MIC ≥2 mg/l and 30-day in-hospital mortality (adjusted Hazard Ratio (aHR) = .80, 95% confidence interval (95%CI) [.30-2.19], p = .67). Factors independently associated with 30-day in-hospital mortality were age ≥75 vs. ≤60 years (aHR =3.72, 95%CI [1.39-9.97], p = .009), absence of active antibiotic treatment (aHR =5.52, 95%CI [1.13-26.87], p = .03) and acute renal failure (aHR =4.45, 95%CI [2.08-9.56], p < .0001). Removal of an infected device had a protective effect against 30-day in-hospital mortality (aHR = .23, 95%CI [.11-.48], p < .0001).
CONCLUSIONS
These results suggest that CoNS bacteraemia should be managed by removal of the infected device and antibiotic treatment such as vancomycin.
背景
万古霉素最低抑菌浓度（MIC）≥2mg/L 对死亡率的影响以及新型抗葡萄球菌药物在凝固酶阴性葡萄球菌（CoNS）菌血症中的潜在获益仍不清楚。我们评估了万古霉素 MIC 对 30 天院内死亡率的影响，并确定了与 30 天院内死亡率独立相关的因素。
方法
纳入了 2008 年 1 月至 2012 年 12 月在兰斯大学医院就诊的 CoNS 菌血症患者。从患者病历中提取数据。采用 E 试验法评估万古霉素 MIC，抗菌药物敏感性试验按照法国微生物学会药敏委员会的建议进行。多变量分析采用 Cox 比例风险模型。
结果
共纳入 269 例患者（平均年龄 61.2±15.7 岁）。92%的患者存在异物，78.4%的分离耐甲氧西林金黄色葡萄球菌的万古霉素 MIC≥2mg/L。30 天院内死亡率为 16%。万古霉素 MIC≥2mg/L 与 30 天院内死亡率无关（校正后的危险比[aHR]为 0.80，95%置信区间[95%CI]为[0.30-2.19]，p=0.67）。与 30 天院内死亡率独立相关的因素为年龄≥75 岁与≤60 岁（aHR=3.72，95%CI [1.39-9.97]，p=0.009）、无积极抗生素治疗（aHR=5.52，95%CI [1.13-26.87]，p=0.03）和急性肾功能衰竭（aHR=4.45，95%CI [2.08-9.56]，p<0.0001）。去除感染性装置具有降低 30 天院内死亡率的保护作用（aHR=0.23，95%CI [0.11-0.48]，p<0.0001）。
结论
这些结果表明，CoNS 菌血症的治疗应通过去除感染性装置和抗生素治疗（如万古霉素）来进行。
Zotero 插件