Lin Tsao-Chin, Hung Yuan-Pin, Lee Ching-Chi, Lin Wei-Tang, Huang Li-Chen, Dai Wei, Kuo Chi-Shuang, Ko Wen-Chien, Huang Yeou-Lih
Department of Medical Laboratory and Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan.
Medical Laboratory, Sinying Hospital, Ministry of Health and Welfare, Tainan, Taiwan.
Infect Drug Resist. 2021 Feb 24;14:689-697. doi: 10.2147/IDR.S297978. eCollection 2021.
Reducing the effectiveness of broad-spectrum cephalosporins against infections has been recognized. This study aimed to investigate risk factors and clinical significance of third-generation cephalosporin nonsusceptibility (3GC-NS) among the cases of monomicrobial bacteremia (mEB) at regional or district hospitals.
The study was conducted at three hospitals in southern Taiwan between Jan. 2017 and Oct. 2019. Only the first episode of mEB from each adult (aged ≥20 years) was included. The primary outcome was in-hospital crude mortality.
Overall there were 499 episodes of adults with mEB included, and their mean age was 74.5 years. Female predominated, accounting for 53% of all patients. (62%) and (21%) were two major causative species. The overall mortality rate was 15% (73/499), and patients infected by 3GC-NS isolates (34%, 172/499) had a higher mortality rate than those by 3GC-susceptible isolates (66%, 327/499) (21% vs 11%, =0.005). By the multivariate analysis, 3GC-NS was the only independent prognostic determinant (adjusted odds ratio [AOR], 1.78; =0.04). Of note, male (AOR 2.02, =0.001), nosocomial-acquired bacteremia (AOR 2.77, <0.001), and usage of nasogastric tube (AOR 2.01, =0.002) were positively associated with 3GC-NS, but bacteremia (AOR 0.28, =0.01) and age (AOR 0.98, =0.04) negatively with 3GC-NS.
For adults with bacteremia, 3GC-NS signifies a significant prognostic impact. Efforts to rapid identification of such antimicrobial resistance profiles should be incorporated into antimicrobial stewardship programs to achieve favorable outcomes.
广谱头孢菌素抗感染效力下降的情况已得到公认。本研究旨在调查地区或区级医院单微生物菌血症（mEB）病例中第三代头孢菌素不敏感（3GC-NS）的危险因素及临床意义。
本研究于2017年1月至2019年10月在台湾南部的三家医院进行。仅纳入每位成年人（年龄≥20岁）的首次mEB发作。主要结局是院内粗死亡率。
共纳入499例成人mEB发作病例，平均年龄为74.5岁。女性居多，占所有患者的53%。[具体细菌名称1]（62%）和[具体细菌名称2]（21%）是两个主要致病菌。总体死亡率为15%（73/499），感染3GC-NS菌株的患者（34%，172/499）的死亡率高于感染3GC敏感菌株的患者（66%，327/499）（21%对11%，P = 0.005）。多因素分析显示，3GC-NS是唯一的独立预后决定因素（校正比值比[AOR]，1.78；P = 0.04）。值得注意的是，男性（AOR 2.02，P = 0.001）、医院获得性菌血症（AOR 2.77，P < 0.001）和使用鼻胃管（AOR 2.01，P = 0.002）与3GC-NS呈正相关，而[具体细菌名称1]菌血症（AOR 0.28，P = 0.01）和年龄（AOR 0.98，P = 0.04）与3GC-NS呈负相关。
对于患有[具体细菌名称1]菌血症的成年人，3GC-NS具有显著的预后影响。应将快速鉴定此类抗菌药物耐药谱的工作纳入抗菌药物管理计划，以取得良好效果。
