Magira E E, Islam S, Niederman M S
Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, 425 East 61st ST, 4th Floor, New York, NY 10065, USA; Department of 1st Critical Care, Evangelismos Hospital, National and Kapodistrian University of Athens, 45-47 Ipsilantou 10676, Athens, Greece.
Department of Biostatistics, Winthrop University Hospital, 222 Station Plaza North, Suite 301, Mineola, NY 11501, USA.
Med Intensiva (Engl Ed). 2018 May;42(4):225-234. doi: 10.1016/j.medin.2017.07.006. Epub 2017 Oct 13.
To define clinical features associated with Intensive Care Unit (ICU) infections caused by multi-drug resistant organisms (MDRO) and their impact on patient outcome.
A single-center, retrospective case-control study was carried out between January 2010 and May 2010.
A medical ICU (MICU) in the United States.
The study included a total of 127 MDRO-positive patients and 186 MDRO-negative patients.
No interventions were carried out.
Out of a total of 313 patients, MDROs were present in 127 (41.7%). Based on the multivariate analysis, only infection as a cause of admission [OR 3.3 (1.9-5.8)]), total days of ventilation [OR 1.07 (1.01-1.12)], total days in hospital [OR 1.04 (1.01-1.07)], immunosuppression [OR 2.04 (1.2-3.5)], a history of hyperlipidemia [OR 2.2 (1.2-3.8)], surgical history [OR 1.82 (1.05-3.14)] and age [OR 1.02 (1.00-1.04)] were identified as clinical factors independently associated to MDROs, while the Caucasian race was negatively associated to MDROs. The distribution of days on ventilation, days in hospital and days of antibiotic treatment prior to infection differed between the MDRO-positive and MDRO-negative groups. The MDRO-positive patients showed a greater median number of days in hospital and days of antibiotic treatment before infection, with a greater median number of days in hospital, days of antibiotic treatment and days of ventilation after infection, compared to the MDRO-negative patients. The mortality rate was not significantly different between the two groups. Appropriate empirical antibiotic therapy was prescribed in 82% of the MDRO-positive cases - such treatment being started within 24h after onset of the infection in 68.5% of the cases.
Defining clinical factors associated with MDRO infections and administering timely and appropriate empirical antibiotic therapy may help reduce the mortality associated with these infections. In our hospital we did not withhold broad spectrum drugs as empirical therapy in patients with clinical features associated to MDRO infection. Our rate of appropriate empirical therapy was therefore high, which could explain the absence of excessive mortality in patients infected with MDROs.
确定与多重耐药菌（MDRO）引起的重症监护病房（ICU）感染相关的临床特征及其对患者预后的影响。
于2010年1月至2010年5月开展了一项单中心回顾性病例对照研究。
美国一家内科重症监护病房（MICU）。
该研究共纳入127例MDRO阳性患者和186例MDRO阴性患者。
未实施干预措施。
在总共313例患者中，127例（41.7%）存在MDRO。基于多变量分析，仅感染作为入院原因[比值比（OR）3.3（1.9 - 5.8）]、机械通气总天数[OR 1.07（1.01 - 1.12）]、住院总天数[OR 1.04（1.01 - 1.07）]、免疫抑制[OR 2.04（1.2 - 3.5）]、高脂血症病史[OR 2.2（1.2 - 3.8）]、手术史[OR 1.82（1.05 - 3.14）]和年龄[OR 1.02（1.00 - 1.04）]被确定为与MDRO独立相关的临床因素，而白种人与MDRO呈负相关。MDRO阳性组和MDRO阴性组在感染前的机械通气天数、住院天数和抗生素治疗天数分布不同。与MDRO阴性患者相比，MDRO阳性患者在感染前的住院天数和抗生素治疗天数中位数更高，感染后的住院天数、抗生素治疗天数和机械通气天数中位数也更高。两组的死亡率无显著差异。82%的MDRO阳性病例给予了适当的经验性抗生素治疗，其中68.5%的病例在感染发生后24小时内开始治疗。
确定与MDRO感染相关的临床因素并给予及时、适当的经验性抗生素治疗可能有助于降低这些感染相关死亡率。在我们医院，对于具有与MDRO感染相关临床特征的患者，我们并未将广谱药物作为经验性治疗而停用。因此，我们的适当经验性治疗率较高，这可以解释MDRO感染患者未出现过高死亡率的原因。
