短期与长期抗生素治疗非复杂性耐万古霉素肠球菌菌血症的回顾性多中心队列研究
Short-course versus long-course antibiotic treatment for uncomplicated vancomycin-resistant enterococcal bacteraemia: a retrospective multicentre cohort study.
作者信息
Bahrs Christina, Rieg Siegbert, Hennigs Annette, Hitzenbichler Florian, Brehm Thomas T, Rose Norman, Jacobi Rebecca J, Heine Valerie, Hornuss Daniel, Huppertz Gunnar, Hagel Stefan, Hanses Frank
机构信息
Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany; Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria.
Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center-University of Freiburg, Freiburg, Germany.
出版信息
Clin Microbiol Infect. 2023 Feb;29(2):200-207. doi: 10.1016/j.cmi.2022.08.023. Epub 2022 Sep 7.
OBJECTIVES
The optimal treatment duration for vancomycin-resistant enterococcal (VRE) bacteraemia is still a matter of debate. The aim of the present study was to compare short-course (≤9 days) and long-course (≥10 days) antibiotic treatments in hospitalized adult patients with uncomplicated VRE bacteraemia.
METHODS
This retrospective study was conducted in four university hospitals in Germany. Adult patients with a positive blood culture for a VRE were screened from 1 January 2016 to 31 December 2018. Only patients who received a VRE-active antibiotic for at least 48 hours were included. The exclusion criteria were a survival of <10 days and a deep-seated source of infection requiring prolonged treatment. To compare the outcome of short-course therapy with that of long-course therapy, 30-day and 90-day overall mortality, relapse within 90 days, duration of hospitalization, and potential antibiotic-related adverse events were analysed by inverse probability of treatment weighting using the propensity score and by additional covariate adjustment.
RESULTS
Of the 363 patients screened, 219 (60.3%) patients were included in the final analysis. Among them, 48 (21.9%) patients had underlying haematological diseases. Seventy-eight (35.6%) patients received short-course treatment (median, 7 days; interquartile range, 5-8 days) and 141 (64.4%) patients received long-course treatment (median, 15 days; interquartile range, 12-23.5 days). Thirty-day mortality was similar in both groups (19.2% vs. 22.0%; adjusted OR, 1.15; p 0.773). Duration of hospitalization (in total and after onset of bacteraemia) was significantly shorter (p < 0.05) in the short-course treatment group, whereas other secondary outcome parameters did not differ between both groups.
DISCUSSION
Our study suggests that short-course treatment might not be associated with a worse outcome in patients with uncomplicated VRE bacteraemia.
目的
耐万古霉素肠球菌（VRE）菌血症的最佳治疗疗程仍存在争议。本研究的目的是比较住院的无并发症VRE菌血症成年患者的短疗程（≤9天）和长疗程（≥10天）抗生素治疗。
方法
本回顾性研究在德国的四家大学医院进行。对2016年1月1日至2018年12月31日血培养VRE阳性的成年患者进行筛查。仅纳入接受VRE活性抗生素治疗至少48小时的患者。排除标准为存活时间<10天以及存在需要长期治疗的深部感染源。为比较短疗程治疗与长疗程治疗的结果，采用倾向评分的治疗加权逆概率法并进行额外的协变量调整，分析30天和90天总死亡率、90天内复发率、住院时间以及潜在的抗生素相关不良事件。
结果
在筛查的363例患者中，219例（60.3%）患者纳入最终分析。其中，48例（21.9%）患者有潜在血液系统疾病。78例（35.6%）患者接受短疗程治疗（中位数7天；四分位间距5 - 8天），141例（64.4%）患者接受长疗程治疗（中位数15天；四分位间距12 - 23.5天）。两组的30天死亡率相似（19.2%对22.0%；调整后OR，1.15；p = 0.773）。短疗程治疗组的住院时间（总计及菌血症发作后）显著更短（p < 0.05），而其他次要结局参数在两组之间无差异。
讨论
我们的研究表明，对于无并发症的VRE菌血症患者，短疗程治疗可能不会导致更差的结局。
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