Zheng Yue, Xu Nana, Pang Jiaojiao, Han Hui, Yang Hongna, Qin Weidong, Zhang Hui, Li Wei, Wang Hao, Chen Yuguo
Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China.
Department of Emergency Medicine, Qilu Hospital of Shandong University, Jinan, China.
Front Med (Lausanne). 2021 Apr 30;8:667776. doi: 10.3389/fmed.2021.667776. eCollection 2021.
is one of the most frequently isolated opportunistic pathogens in intensive care units (ICUs). Extensively drug-resistant (XDR-AB) strains lack susceptibility to almost all antibiotics and pose a heavy burden on healthcare institutions. In this study, we evaluated the impact of XDR-AB colonization on both the short-term and long-term survival of critically ill patients. We prospectively enrolled patients from two adult ICUs in Qilu Hospital of Shandong University from March 2018 through December 2018. Using nasopharyngeal and perirectal swabs, we evaluated the presence of XDR-AB colonization. Participants were followed up for 6 months. The primary endpoints were 28-day and 6-month mortality after ICU admission. The overall survival rate was estimated by the Kaplan-Meier method. We identified risk factors associated with 28-day and 6-month mortality using the logistic regression model and a time-dependent Cox regression model, respectively. Out of 431 patients, 77 were colonized with XDR-AB. Based on the Kaplan-Meier curve results, the overall survival before 28 days did not differ by colonization status; however, a significantly lower overall survival rate was obtained at 6 months in colonized patients. Univariate and multivariate analysis results confirmed that XDR-AB colonization was not associated with 28-day mortality, but was an independent risk factor of lower overall survival at 6 months (HR = 1.749, 95% CI = 1.174-2.608). XDR-AB colonization has no effect on short-term overall survival, but is associated with lower long-term overall survival in critically ill patients.
是重症监护病房（ICU）中最常分离出的机会性病原体之一。广泛耐药（XDR-AB）菌株对几乎所有抗生素均不敏感，给医疗机构带来沉重负担。在本研究中，我们评估了XDR-AB定植对重症患者短期和长期生存的影响。我们前瞻性地纳入了2018年3月至2018年12月山东大学齐鲁医院两个成人ICU的患者。通过鼻咽和直肠拭子，我们评估了XDR-AB定植情况。对参与者进行了6个月的随访。主要终点是ICU入院后28天和6个月的死亡率。采用Kaplan-Meier法估计总体生存率。我们分别使用逻辑回归模型和时间依赖性Cox回归模型确定与28天和6个月死亡率相关的危险因素。在431例患者中，77例被XDR-AB定植。根据Kaplan-Meier曲线结果，28天前的总体生存率在定植状态方面没有差异；然而，定植患者在6个月时的总体生存率显著较低。单因素和多因素分析结果证实，XDR-AB定植与28天死亡率无关，但却是6个月时总体生存率降低的独立危险因素（HR = 1.749，95%CI = 1.174-2.608）。XDR-AB定植对短期总体生存没有影响，但与重症患者较低的长期总体生存相关。
