Department of Pulmonology and Critical Care Medicine, University of California, Los Angeles, Los Angeles, California, USA
NIH BD2K Center of Excellence at UCLA, University of California, Los Angeles, Los Angeles, California, USA.
J Clin Microbiol. 2018 Aug 27;56(9). doi: 10.1128/JCM.00149-18. Print 2018 Sep.
Infections due to colistin-resistant (Col) Gram-negative rods (GNRs) and colistin-resistant isolates in particular result in high associated mortality and poor treatment options. To determine the risk factors for recovery on culture of Col GNRs and Col, analyses were chosen to aid decisions at two separate time points: the first when only Gram stain results are available without any bacterial species information (corresponding to the Col GNR model) and the second when organism identification is performed but prior to reporting of antimicrobial susceptibility testing results (corresponding to the Col model). Cases were retrospectively analyzed at a major academic hospital system from 2011 to 2016. After excluding bacteria that were intrinsically resistant to colistin, a total of 28,512 GNR isolates (4,557 isolates) were analyzed, 128 of which were Col (i.e., MIC > 2 μg/ml), including 68 of which that were Col In multivariate analysis, risk factors for Col GNRs were neurologic disease, residence in a skilled nursing facility prior to admission, receipt of carbapenems in the last 90 days, prior infection with a carbapenem-resistant organism, and receipt of ventilatory support (-statistic = 0.81). Risk factors for Col specifically were neurologic disease, residence in a skilled nursing facility prior to admission, receipt of carbapenems in the last 90 days, receipt of an anti-methicillin-resistant antimicrobial in the last 90 days, and prior infection with a carbapenem-resistant organism (-statistic = 0.89). A scoring system derived from these models can be applied by providers to guide empirical antimicrobial therapy in patients with infections with suspected Col GNR and Col isolates.
耐粘菌素（Col）革兰氏阴性菌（GNR）和耐粘菌素的感染尤其导致高死亡率和较差的治疗选择。为了确定培养耐粘菌素 GNR 和耐粘菌素的危险因素，选择了分析来帮助在两个不同时间点做出决策：第一个时间点仅在没有任何细菌种类信息的情况下提供革兰氏染色结果（对应于 Col GNR 模型），第二个时间点是在进行生物体鉴定但在报告抗生素敏感性测试结果之前（对应于 Col 模型）。对 2011 年至 2016 年期间的一个主要学术医院系统进行了回顾性分析。在排除对粘菌素固有耐药的细菌后，总共分析了 28512 个 GNR 分离株（4557 个分离株），其中 128 个为 Col（即 MIC > 2μg/ml），其中 68 个为 Col。在多变量分析中，耐粘菌素 GNR 的危险因素包括神经疾病、入院前在熟练护理设施居住、在过去 90 天内接受碳青霉烯类药物、以前感染过耐碳青霉烯类药物的生物体以及接受通气支持（-统计量=0.81）。Col 的危险因素包括神经疾病、入院前在熟练护理设施居住、在过去 90 天内接受碳青霉烯类药物、在过去 90 天内接受抗耐甲氧西林的抗菌药物治疗以及以前感染过耐碳青霉烯类药物的生物体（-统计量=0.89）。可以由提供者应用从这些模型中得出的评分系统来指导经验性抗生素治疗怀疑患有耐粘菌素 GNR 和耐粘菌素分离株感染的患者。
