Uda Atsushi, Shigemura Katsumi, Kitagawa Koichi, Osawa Kayo, Onuma Kenichiro, Yan Yonmin, Nishioka Tatsuya, Fujisawa Masato, Yano Ikuko, Miyara Takayuki
Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan.
Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan.
Antibiotics (Basel). 2021 Jan 11;10(1):64. doi: 10.3390/antibiotics10010064.
The incidence of bacteremia caused by , which is highly resistant to multiple antibiotics, is increasing in Japan. However, risk factors for the acquisition of infection and mortality due to enterococcal bacteremia are not well known. We compared demographic, microbiological, and clinical characteristics using a Cox regression model and univariate analysis. We performed a multivariate analysis to identify risk factors for patients treated between 2014 and 2018. Among 186 patients with enterococcal bacteremia, two groups included in the Kaplan-Meier analysis ( (n = 88) and (n = 94)) showed poor overall survival in the group (HR: 1.92; 95% confidence interval: 1.01-3.66; = 0.048). The median daily antibiotic cost per patient in the group was significantly higher than that in the group ($23 ($13-$34) vs. $34 ($22-$58), < 0.001). strains were more frequently identified with previous use of antipseudomonal penicillins (OR = 4.04, < 0.001) and carbapenems (OR = 3.33, = 0.003). Bacteremia from an unknown source (OR = 2.79, = 0.025) and acute kidney injury (OR = 4.51, = 0.004) were associated with higher risks of 30-day mortality in patients with enterococcal bacteremia. Therefore, clinicians should provide improved medical management, with support from specialized teams such as those assisting antimicrobial stewardship programs.
在日本，对多种抗生素具有高度耐药性的[细菌名称]引起的菌血症发病率正在上升。然而，肠球菌菌血症的感染获得风险因素和死亡率尚不清楚。我们使用Cox回归模型和单变量分析比较了人口统计学、微生物学和临床特征。我们进行了多变量分析，以确定2014年至2018年期间接受治疗的患者的风险因素。在186例肠球菌菌血症患者中，Kaplan-Meier分析纳入的两组（[组1名称]（n = 88）和[组2名称]（n = 94））显示[组1名称]组的总体生存率较差（HR：1.92；95%置信区间：1.01 - 3.66；P = 0.048）。[组1名称]组每位患者的每日抗生素成本中位数显著高于[组2名称]组（23美元（13 - 34美元）对34美元（22 - 58美元），P < 0.001）。[细菌名称]菌株在先前使用抗假单胞菌青霉素（OR = 4.04，P < 0.001）和碳青霉烯类药物（OR = 3.33，P = 0.003）的患者中更频繁地被鉴定出来。不明来源的菌血症（OR = 2.79，P = 0.025）和急性肾损伤（OR = 4.51，P = 0.004）与肠球菌菌血症患者30天死亡率的较高风险相关。因此，临床医生应在抗菌药物管理计划等专业团队的支持下，提供改进的医疗管理。
