Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.
Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark.
Infect Control Hosp Epidemiol. 2022 Jun;43(6):719-727. doi: 10.1017/ice.2021.216. Epub 2021 Jun 21.
To study whether replacement of nosocomial ampicillin-resistant (ARE) clones by vancomycin-resistant (VRE), belonging to the same genetic lineages, increases mortality in patients with bacteremia, and to evaluate whether any such increase is mediated by a delay in appropriate antibiotic therapy.
Retrospective, matched-cohort study.
The study included 20 Dutch and Danish hospitals from 2009 to 2014.
Within the study period, 63 patients with VRE bacteremia (36 Dutch and 27 Danish) were identified and subsequently matched to 234 patients with ARE bacteremia (130 Dutch and 104 Danish) for hospital, ward, length of hospital stay prior to bacteremia, and age. For all patients, 30-day mortality after bacteremia onset was assessed.
The risk ratio (RR) reflecting the impact of vancomycin resistance on 30-day mortality was estimated using Cox regression with further analytic control for confounding factors.
The 30-day mortality rates were 27% and 38% for ARE in the Netherlands and Denmark, respectively, and the 30-day mortality rates were 33% and 48% for VRE in these respective countries. The adjusted RR for 30-day mortality for VRE was 1.54 (95% confidence interval, 1.06-2.25). Although appropriate antibiotic therapy was initiated later for VRE than for ARE bacteremia, further analysis did not reveal mediation of the increased mortality risk.
Compared to ARE bacteremia, VRE bacteremia was associated with higher 30-day mortality. One explanation for this association would be increased virulence of VRE, although both phenotypes belong to the same well-characterized core genomic lineage. Alternatively, it may be the result of unmeasured confounding.
研究耐医院内氨苄青霉素（ARE）的克隆被耐万古霉素（VRE）克隆取代是否会增加菌血症患者的死亡率，并评估这种增加是否是由于抗生素治疗的延迟引起的。
回顾性匹配队列研究。
该研究包括 2009 年至 2014 年期间荷兰和丹麦的 20 家医院。
在研究期间，确定了 63 例 VRE 菌血症（36 例荷兰人和 27 例丹麦人），并随后与 234 例 ARE 菌血症（130 例荷兰人和 104 例丹麦人）进行匹配，匹配因素包括医院、病房、菌血症前的住院时间和年龄。对所有患者进行菌血症发病后 30 天的死亡率评估。
使用 Cox 回归估计反映万古霉素耐药对 30 天死亡率影响的风险比（RR），并进一步分析控制混杂因素。
荷兰 ARE 的 30 天死亡率为 27%，丹麦 ARE 的 30 天死亡率为 38%，相应国家 VRE 的 30 天死亡率分别为 33%和 48%。VRE 菌血症 30 天死亡率的调整 RR 为 1.54（95%置信区间，1.06-2.25）。虽然 VRE 菌血症比 ARE 菌血症更晚开始使用适当的抗生素治疗，但进一步的分析并未显示出增加的死亡率风险的中介作用。
与 ARE 菌血症相比，VRE 菌血症与更高的 30 天死亡率相关。这种关联的一个解释可能是 VRE 的毒力增加，尽管两种表型都属于同一个特征明确的核心基因组谱系。或者，这可能是由于未测量的混杂因素造成的。
