Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA
Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California, USA.
Antimicrob Agents Chemother. 2018 Jan 25;62(2). doi: 10.1128/AAC.01554-17. Print 2018 Feb.
The objective of this retrospective study was to compare the rates of treatment failure, which was a composite of clinical and microbiologic failure, of patients receiving vancomycin and a β-lactam to those receiving vancomycin only for methicillin-resistant (MRSA) bacteremia. Patients 16 to 89 years of age with MRSA bacteremia admitted to a university-affiliated hospital from 1 January 2014 to 31 December 2016 were screened for study inclusion. Patients were eligible if they received >48 h of vancomycin and a β-lactam (combination group) or vancomycin only (standard group) within 48 h after bacteremia onset. A total of 182 patients were screened: 47 were included in the standard group, and 63 were in the combination group. The combination group had a higher baseline body mass index (29.2 ± 8.0 kg/m versus 25.8 ± 7.1 kg/m, = 0.022), acute physiologic assessment and chronic health evaluation-II (APACHE-II) score (median [interquartile range], 21 [15 to 26] versus 16 [10 to 22], = 0.003), and incidence of septic shock (31.8% versus 14.9%, = 0.047). Using multivariate analysis, combination therapy was the only variable that decreased treatment failures (odds ratio [95% confidence interval], 0.337 [0.142 to 0.997]), while vancomycin MIC > 1 mg/liter and male gender increased treatment failures (4.018 [1.297 to 12.444] and 2.971 [1.040 to 8.488], respectively). The 30-day mortality rates (15.0% versus 14.9%, = 1.000) and the incidence of adverse drug events (19.1% versus 23.4%, = 0.816) were not statistically different between the combination and standard groups. Combination therapy of vancomycin with a β-lactam led to significantly fewer treatment failures than vancomycin monotherapy for MRSA bacteremia.
这项回顾性研究的目的是比较接受万古霉素和β-内酰胺治疗与仅接受万古霉素治疗的耐甲氧西林金黄色葡萄球菌（MRSA）菌血症患者的治疗失败率，治疗失败的复合终点为临床和微生物学失败。2014 年 1 月 1 日至 2016 年 12 月 31 日，筛选了入住一所大学附属医院的年龄在 16 至 89 岁之间、患有 MRSA 菌血症的患者，以纳入本研究。如果患者在菌血症发病后 48 小时内接受了>48 小时的万古霉素和β-内酰胺（联合组）或仅万古霉素（标准组）治疗，则有资格入组。共筛选了 182 例患者：47 例纳入标准组，63 例纳入联合组。联合组的基线体重指数（29.2 ± 8.0 kg/m2 与 25.8 ± 7.1 kg/m2，= 0.022）、急性生理评估和慢性健康评估-II（APACHE-II）评分（中位数[四分位距]，21 [15 至 26] 与 16 [10 至 22]，= 0.003）和败血症性休克的发生率（31.8%与 14.9%，= 0.047）更高。多变量分析显示，联合治疗是唯一降低治疗失败率的变量（比值比[95%置信区间]，0.337 [0.142 至 0.997]），而万古霉素 MIC > 1 mg/l 及男性则增加了治疗失败率（4.018 [1.297 至 12.444] 和 2.971 [1.040 至 8.488]）。联合组和标准组的 30 天死亡率（15.0%与 14.9%，= 1.000）和不良药物事件发生率（19.1%与 23.4%，= 0.816）无统计学差异。与万古霉素单药治疗相比，万古霉素联合β-内酰胺治疗可显著降低 MRSA 菌血症的治疗失败率。
