Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, 1161 21st Ave S., T-1218 MCN, Nashville, 37232-2650, TN, USA.
Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.
Crit Care. 2018 Oct 26;22(1):266. doi: 10.1186/s13054-018-2206-7.
Central line-associated bloodstream infections (CLABSIs) are associated with increased mortality, hospital length of stay, and cost. Antimicrobial treatment guidelines for CLABSIs are primarily based on expert opinion. We hypothesized that shorter antimicrobial treatment duration is associated with decreased 60-day recurrence-free survival.
A retrospective cohort study of all adults with hospital-acquired CLABSIs (HA-CLABSIs) over 5 years at a single tertiary care academic hospital was performed. The time from the end of effective antimicrobial treatment until recurrence of infection or mortality, censored at 60 days after the end of antimicrobial treatment, represented the primary outcome. Effective antimicrobial treatment was defined as the administration of at least one antimicrobial to which the causative organism was sensitive.
A total of 366 cases met eligibility criteria. The median Sequential Organ Failure Assessment (SOFA) score was 6 (interquartile range (IQR) 4-8). Patients were treated for a median of 15 (IQR 10-20) days with effective antimicrobials. The incidence of 60-day mortality or recurrence after completion of the antimicrobial course was 22.1% (81 patients). In a Cox proportional-hazards model, antimicrobial treatment duration (hazard ratio (HR) = 0.35; 95% confidence interval (CI) 0.26-0.48), SOFA score (HR = 1.16; 95% CI 1.09-1.22), and age (HR = 1.021; 95% CI = 1.004-1.037) were associated with mortality or recurrence. The effect of antimicrobial treatment duration appeared to plateau after 15 days.
Longer antimicrobial treatment duration in patients with HA-CLABSIs is associated with improved recurrence-free survival during the first 60 days after infection. This effect appears to plateau after 15 days of treatment. Prospective studies are needed to definitively determine the optimal antimicrobial treatment duration for CLABSIs.
中心静脉相关血流感染（CLABSI）与死亡率增加、住院时间延长和费用增加有关。CLABSI 的抗菌治疗指南主要基于专家意见。我们假设较短的抗菌治疗持续时间与 60 天无复发生存降低有关。
对一家三级保健学术医院 5 年来所有成人获得性 CLABSI（HA-CLABSI）进行回顾性队列研究。从有效抗菌治疗结束到感染复发或死亡的时间（以抗菌治疗结束后 60 天为截止点）为主要结局。有效抗菌治疗定义为给予至少一种对病原体敏感的抗菌药物。
共纳入 366 例符合条件的病例。中位序贯器官衰竭评估（SOFA）评分 6 分（四分位间距（IQR）4-8 分）。患者接受有效抗菌药物治疗的中位数为 15 天（IQR 10-20 天）。抗菌疗程结束后 60 天死亡率或复发的发生率为 22.1%（81 例）。在 Cox 比例风险模型中，抗菌治疗持续时间（风险比（HR）=0.35；95%置信区间（CI）0.26-0.48）、SOFA 评分（HR=1.16；95%CI 1.09-1.22）和年龄（HR=1.021；95%CI 1.004-1.037）与死亡率或复发相关。抗菌治疗持续时间的影响似乎在 15 天后达到平台期。
HA-CLABSI 患者的抗菌治疗持续时间较长与感染后 60 天内无复发生存改善相关。这种效果在治疗 15 天后似乎达到平台期。需要前瞻性研究来确定 CLABSI 的最佳抗菌治疗持续时间。
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