Center of Infectious Disease, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China.
Center of Infectious Disease, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu 610041, China.
Int J Antimicrob Agents. 2021 Mar;57(3):106284. doi: 10.1016/j.ijantimicag.2021.106284. Epub 2021 Jan 20.
Carbapenem-resistant Gram-negative bacterial bloodstream infection (CRGNB-BSI) has become a rapidly growing global threat with limited antibiotic options and significant mortality. The aim of this study was to explore the antibiotic strategies and clinical outcomes of patients with CRGNB-BSI in Western China. We retrospectively investigated the demographic, microbiological and clinical characteristics of 355 patients with CRGNB-BSI from 2012-2017. Treatment failure and 28-day in-hospital mortality rates were 49.3% (175/355) and 23.7% (84/355), respectively. The most frequently isolated micro-organism was Acinetobacter baumannii (58.6%; 208/355). Patients with treatment failure had higher procalcitonin and interleukin-6 levels (P < 0.05). High-dosage tigecycline therapy (200 mg loading dose followed by 100 mg every 12 h) was not superior to standard tigecycline dosing (P > 0.05). Multivariable analysis revealed that multiple organ dysfunction syndrome (MODS) (OR = 2.226, 95% CI 1.376-3.602; P = 0.001) and intensive care unit (ICU) admission (OR = 3.116, 95% CI 1.905-5.097; P = 0.000) were independent risk factors for treatment failure, whereas monotherapy (OR = 0.386, 95% CI 0.203-0.735; P = 0.004) had a protective effect. Survival analysis revealed that inappropriate therapy, MODS and ICU admission were associated with a higher 28-day in-hospital mortality rate (P < 0.001). Combination antimicrobial therapy was not superior to monotherapy (P = 0.387). This study demonstrates that appropriate therapy is significantly associated with lower treatment failure and 28-day in-hospital mortality rates. Tigecycline might not be a suitable option for CRGBN-BSI. Patients with MODS and admitted to the ICU had poor clinical outcomes.
碳青霉烯类耐药革兰氏阴性菌血流感染（CRGNB-BSI）已成为一个快速增长的全球性威胁，抗生素选择有限，死亡率高。本研究旨在探讨中国西部 CRGNB-BSI 患者的抗生素策略和临床结局。我们回顾性调查了 2012 年至 2017 年间 355 例 CRGNB-BSI 患者的人口统计学、微生物学和临床特征。治疗失败和 28 天院内死亡率分别为 49.3%（175/355）和 23.7%（84/355）。最常分离的微生物是鲍曼不动杆菌（58.6%，208/355）。治疗失败的患者降钙素原和白细胞介素-6 水平较高（P<0.05）。高剂量替加环素治疗（200mg 负荷剂量，随后 100mg 每 12h）并不优于标准替加环素剂量（P>0.05）。多变量分析显示，多器官功能障碍综合征（MODS）（OR=2.226，95%CI 1.376-3.602；P=0.001）和重症监护病房（ICU）入住（OR=3.116，95%CI 1.905-5.097；P=0.000）是治疗失败的独立危险因素，而单药治疗（OR=0.386，95%CI 0.203-0.735；P=0.004）具有保护作用。生存分析显示，不适当的治疗、MODS 和 ICU 入住与 28 天院内死亡率较高相关（P<0.001）。联合抗菌治疗并不优于单药治疗（P=0.387）。本研究表明，适当的治疗与较低的治疗失败和 28 天院内死亡率显著相关。替加环素可能不是治疗 CRGBN-BSI 的合适选择。有 MODS 且入住 ICU 的患者临床结局较差。
