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跨多家社区医院的铜绿假单胞菌菌血症的临床特征、经验性抗生素治疗的适宜性和结局。

Clinical characteristics, appropriateness of empiric antibiotic therapy, and outcome of Pseudomonas aeruginosa bacteremia across multiple community hospitals.

机构信息

HealthTrust Supply Chain, South Atlantic Division, Charleston, USA.

, 900 Island Park Drive, Suite 290, Charleston, 29492, USA.

出版信息

Eur J Clin Microbiol Infect Dis. 2022 Jan;41(1):53-62. doi: 10.1007/s10096-021-04342-y. Epub 2021 Aug 30.

DOI:10.1007/s10096-021-04342-y
PMID:34462815
Abstract

There is relatively little contemporary information regarding clinical characteristics of patients with Pseudomonas aeruginosa bacteremia (PAB) in the community hospital setting. This was a retrospective, observational cohort study examining the clinical characteristics of patients with PAB across several community hospitals in the USA with a focus on the appropriateness of initial empirical therapy and impact on patient outcomes. Cases of PAB occurring between 2016 and 2019 were pulled from 8 community medical centers. Patients were classified as having either positive or negative outcome at hospital discharge. Several variables including receipt of active empiric therapy (AET) and the time to receiving AET were collected. Variables with a p value of < 0.05 in univariate analyses were included in a multivariable logistic regression model. Two hundred and eleven episodes of PAB were included in the analysis. AET was given to 81.5% of patients and there was no difference in regard to outcome (p = 0.62). There was no difference in the median time to AET in patients with a positive or negative outcome (p = 0.53). After controlling for other variables, age, Pitt bacteremia score ≥ 4, and septic shock were independently associated with a negative outcome. A high proportion of patients received timely, active antimicrobial therapy for PAB and time to AET did not have a significant impact on patient outcome.

摘要

关于社区医院中铜绿假单胞菌菌血症(PAB)患者的临床特征,目前仅有相对较少的当代信息。这是一项回顾性观察性队列研究,在美国的几家社区医院中检查了 PAB 患者的临床特征,重点关注初始经验性治疗的适当性及其对患者结局的影响。2016 年至 2019 年间发生的 PAB 病例从 8 家社区医疗中心中提取。根据患者出院时的情况将其分为阳性或阴性结局。收集了包括接受积极经验性治疗(AET)和接受 AET 的时间在内的几个变量。单变量分析中 p 值<0.05 的变量被纳入多变量逻辑回归模型。分析共纳入 211 例 PAB 发作。81.5%的患者接受了 AET,但其结局没有差异(p=0.62)。阳性或阴性结局患者接受 AET 的中位数时间无差异(p=0.53)。在控制其他变量后,年龄、Pitt 菌血症评分≥4 和感染性休克与不良结局独立相关。很大一部分 PAB 患者接受了及时、积极的抗菌治疗,而 AET 时间对患者结局没有显著影响。

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