Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Medical Center, College of Medicine, Texas A & M University, Temple, TX; and.
Department of Biostatistics¸ Baylor Scott & White Medical Center, Temple, TX.
Am J Ther. 2020 Sep 4;28(4):e388-e396. doi: 10.1097/MJT.0000000000001127.
Vancomycin-resistant Enterococcus (VRE) bacteremia has significant morbidity and mortality. Empiric antibiotic regimens for treating patients with risk factors for multidrug-resistant organisms may not have medications directed at treating VRE.
To evaluate the impact of antibiotic therapy (and other risk factors) on mortality in VRE bacteremia.
We identified 146 patients with VRE bacteremia, admitted at our institution over an 11 years period (2004-2014). All inpatients with an initial positive VRE blood culture were included only once in the analysis. Eighteen patients were excluded from the study because of inability to retrieve medical information regarding one or more important study variables. The retrospectively collected data from electronic medical records of 128 patients were analyzed.
The inpatient, 30-day, and 1-year mortality rates from VRE bacteremia were 23%, 31%, and 59%, respectively. Only 19% patients were discharged home. Inappropriate antibiotics were prescribed in 19% patients. Appropriate antibiotics were prescribed in 81% patients (62% daptomycin and 37% linezolid); however, only 58% patients received appropriate antibiotics within 24 hours of the reported positive blood cultures. The 30-day and 1-year mortality rates for patients treated with inappropriate antibiotics were 54% and 67% compared with 26% and 50%, respectively, for those treated with appropriate antibiotics. The median survival rate for patients treated with inappropriate antibiotics was 1 month (95% confidence interval: 0.0-1.0) compared with 11 months (95% confidence interval: 4.0-13.0) for those treated with appropriate antibiotics. The advanced patient age (median age 75 years vs. 63 years) was a significant risk factor for inappropriate antibiotic therapy (P value = 0.02). The multivariate Cox regression model revealed inappropriate antibiotic therapy (P value = 0.003), septic shock (P value = 0.0004), albumin (P value = 0.04), and dementia (P value = 0.003) to be associated with 30-day mortality.
Our study highlights the detrimental effect of inappropriate antibiotic therapy and other risk factors on morbidity and mortality associated with VRE bacteremia.
耐万古霉素肠球菌（VRE）菌血症具有显著的发病率和死亡率。针对具有多重耐药菌危险因素的患者，经验性抗生素治疗方案可能没有针对 VRE 的药物。
评估抗生素治疗（和其他危险因素）对 VRE 菌血症患者死亡率的影响。
我们确定了 146 例在我院住院期间发生 VRE 菌血症的患者，这些患者的时间跨度为 11 年（2004 年至 2014 年）。所有初始 VRE 血培养阳性的住院患者在分析中仅被纳入一次。由于无法检索 18 例患者的一项或多项重要研究变量的医疗信息，这 18 例患者被排除在研究之外。我们对 128 例患者的电子病历中回顾性收集的数据进行了分析。
VRE 菌血症患者的住院死亡率、30 天死亡率和 1 年死亡率分别为 23%、31%和 59%。只有 19%的患者出院回家。19%的患者接受了不适当的抗生素治疗。81%的患者接受了适当的抗生素治疗（62%为达托霉素，37%为利奈唑胺）；然而，只有 58%的患者在报告阳性血培养后的 24 小时内接受了适当的抗生素治疗。接受不适当抗生素治疗的患者 30 天和 1 年死亡率分别为 54%和 67%，而接受适当抗生素治疗的患者分别为 26%和 50%。接受不适当抗生素治疗的患者中位生存时间为 1 个月（95%置信区间：0.0-1.0），而接受适当抗生素治疗的患者中位生存时间为 11 个月（95%置信区间：4.0-13.0）。患者年龄较大（中位年龄 75 岁 vs. 63 岁）是接受不适当抗生素治疗的显著危险因素（P 值=0.02）。多变量 Cox 回归模型显示，不适当的抗生素治疗（P 值=0.003）、感染性休克（P 值=0.0004）、白蛋白（P 值=0.04）和痴呆（P 值=0.003）与 30 天死亡率相关。
我们的研究强调了不适当的抗生素治疗和其他危险因素对 VRE 菌血症相关发病率和死亡率的有害影响。
