携带多重耐药菌的菌血症患者中多重耐药菌导致菌血症的相关因素：病例对照研究。
Factors associated with bacteraemia due to multidrug-resistant organisms among bacteraemic patients with multidrug-resistant organism carriage: a case control study.
机构信息
1Infectious disease unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France.
2Pharmacy department, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd R. Poincaré, 92380 Garches, France.
出版信息
Antimicrob Resist Infect Control. 2018 Sep 29;7:116. doi: 10.1186/s13756-018-0412-3. eCollection 2018.
BACKGROUND
Infections caused by multidrug-resistant organisms (MDRO) are emerging worldwide. Physicians are increasingly faced with the question of whether patients need empiric antibiotic treatment covering these pathogens. This question is especially essential among MDRO carriers. We aim to determine the occurrence of MDRO bacteraemia among bacteraemic patients colonized with MDRO, and the associated factors with MDRO bacteraemia among this population.
METHODS
We performed a retrospective monocentric study among MDRO carriers hospitalized with bacteraemia between January 2013 and August 2016 in a French hospital. We compared characteristics of patients with MDRO and non-MDRO bacteraemia.
RESULTS
Overall, 368 episodes of bacteraemia were reviewed; 98/368 (26.6%) occurred among MDRO carriers.Main colonizing bacteria were extended-spectrum beta-lactamase (ESBL)-producing (40/98; 40.8%), ESBL-producing (35/98; 35.7%); methicillin-resistant (26/98; 26.5%) and multidrug-resistant (PA) (12/98; 12.2%).There was no significant difference considering population with MDRO bacteraemia vs. non-MDRO bacteraemia, except for immunosuppression [OR 2.86; = 0.0207], severity of the episode [OR 3.13; = 0.0232], carriage of PA [OR 5.24; = 0.0395], and hospital-acquired infection [OR 2.49; = 0.034].In the multivariate analysis, factors significantly associated with MDRO bacteraemia among colonized patient were only immunosuppression [OR = 2.96; = 0.0354] and the hospital-acquired origin of bacteraemia [OR = 2.62; = 0.0427].
CONCLUSIONS
According to our study, occurrence of bacteraemia due to MDRO among MDRO carriers was high. Factors associated with MDRO bacteraemia were severity of the episode and hospital-acquired origin of the bacteraemia. Thus, during bacteraemia among patients colonized with MDRO, if such characteristics are present, broad-spectrum antimicrobial treatment is recommended.
背景
全球范围内，由耐多药病原体（MDRO）引起的感染正在出现。医生越来越多地面临这样一个问题，即携带 MDRO 的患者是否需要经验性抗生素治疗来覆盖这些病原体。对于 MDRO 携带者来说，这个问题尤为重要。我们旨在确定 MDRO 菌血症患者中 MDRO 菌血症的发生率，以及该人群中 MDRO 菌血症相关的因素。
方法
我们在一家法国医院进行了一项回顾性单中心研究，纳入 2013 年 1 月至 2016 年 8 月间因菌血症住院的 MDRO 携带者。我们比较了 MDRO 菌血症患者和非 MDRO 菌血症患者的特征。
结果
共回顾了 368 例菌血症发作，其中 98/368（26.6%）发生在 MDRO 携带者中。主要定植菌为产超广谱β-内酰胺酶（ESBL）的 （40/98；40.8%）、产 ESBL 的 （35/98；35.7%）、耐甲氧西林 （26/98；26.5%）和多重耐药 （PA）（12/98；12.2%）。除了免疫抑制[比值比（OR）2.86；=0.0207]、感染严重程度[OR 3.13；=0.0232]、携带 PA[OR 5.24；=0.0395]和医院获得性感染[OR 2.49；=0.034]外，MDRO 菌血症患者和非 MDRO 菌血症患者之间无显著差异。多变量分析显示，定植患者中与 MDRO 菌血症相关的因素仅为免疫抑制[OR=2.96；=0.0354]和菌血症的医院获得性来源[OR=2.62；=0.0427]。
结论
根据我们的研究，MDRO 携带者中 MDRO 菌血症的发生率较高。与 MDRO 菌血症相关的因素是感染的严重程度和菌血症的医院获得性来源。因此，在 MDRO 定植患者发生菌血症时，如果存在这些特征，建议进行广谱抗菌治疗。
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