Maia Marcelo de Oliveira, da Silveira Carlos Darwin Gomes, Gomes Maura, Fernandes Sérgio Eduardo Soares, Bezerra de Santana Rosália, de Oliveira Daniella Queiroz, Amorim Felipe Ferreira Pontes, Neves Francisco de Assis Rocha, Amorim Fábio Ferreira
Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil.
Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil.
Infect Drug Resist. 2023 Mar 23;16:1693-1704. doi: 10.2147/IDR.S401754. eCollection 2023.
To evaluate the effect of MDRO infection on hospital mortality and the risk factors among critically ill patients with sepsis at hospital admission.
A cross-sectional study was performed between April 2019 and May 2020, followed by a cohort to evaluate hospital mortality that prospectively included all consecutive patients 18 years or older with sepsis admitted within 48 hours of hospital admission to an adult ICU in Brazil. Patients' characteristics, blood samples within one hour of ICU admission, and microbiological results within 48h of hospital admission were collected. In addition, descriptive statistics, binary logistic regression, and propensity score matching were performed.
At least one MDRO was isolated in 85 patients (9.8%). The extended-spectrum beta-lactamase-producing Enterobacterales are the most frequent organism (56.1%). Hypoxemic acute respiratory failure (OR 1.87, 95% CI 1.02-3.40, p = 0.04), Glasgow Coma Score below 15 (OR 2.57, 95% CI 1.38-4.80, p < 0.01), neoplasm (OR 2.66, 95% CI 1.04-6.82, p = 0.04) and hemoglobin below 10.0 g/dL (OR 1.82, 95% CI 1.05-3.16, p = 0.03) were associated with increased MDRO. Admission from the Emergency Department (OR 0.25, 95% CI 0.14-0.43, p < 0.01) was associated with decreased MDRO. In the multivariate analysis, MDRO at hospital admission increased hospital mortality (OR 2.80, 95% CI 1.05-7.42, p = 0.04). After propensity score-matching adjusted to age, APACHE II, SOFA, and dementia, MDRO at hospital admission was associated with significantly high hospital mortality (OR 2.80, 95% CI 1.05-7.42, p = 0.04). The E-value of adjusted OR for the effect of MDRO infection on hospital mortality was 3.41, with a 95% CI of 1.31, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect.
MDRO infection increased hospital mortality, and MDRO risk factors should be accessed even in patients admitted to ICU within 48 hours of hospital admission.
评估多重耐药菌（MDRO）感染对医院死亡率的影响以及入院时患有脓毒症的重症患者的风险因素。
于2019年4月至2020年5月进行了一项横断面研究，随后进行了一项队列研究以评估医院死亡率，该队列前瞻性纳入了巴西一家成人重症监护病房（ICU）在入院48小时内收治的所有18岁及以上的连续脓毒症患者。收集了患者的特征、入住ICU后1小时内的血样以及入院后48小时内的微生物学结果。此外，还进行了描述性统计、二元逻辑回归和倾向得分匹配。
85例患者（9.8%）分离出至少一种MDRO。产超广谱β-内酰胺酶的肠杆菌科细菌是最常见的病原体（56.1%）。低氧性急性呼吸衰竭（比值比[OR]1.87，95%置信区间[CI]1.02 - 3.40，p = 0.04）、格拉斯哥昏迷评分低于15分（OR 2.57，95% CI 1.38 - 4.80，p < 0.01）、肿瘤（OR 2.66，95% CI 1.04 - 6.82，p = 0.04）以及血红蛋白低于10.0 g/dL（OR 1.82，95% CI 1.05 - 3.16，p = 0.03）与MDRO感染增加相关。从急诊科入院（OR 0.25，95% CI 0.14 - 0.43，p < 0.01）与MDRO感染减少相关。在多变量分析中，入院时的MDRO感染增加了医院死亡率（OR 2.80，95% CI 1.05 - 7.42，p = 0.04）。在根据年龄、急性生理与慢性健康状况评分系统II（APACHE II）、序贯器官衰竭评估（SOFA）和痴呆进行倾向得分匹配后，入院时的MDRO感染与显著较高的医院死亡率相关（OR 2.80，95% CI 1.05 - 7.42，p = 0.04）。MDRO感染对医院死亡率影响的调整后OR的E值为3.41，95% CI为1.31，这表明未测量的混杂因素不太可能解释全部影响。
MDRO感染增加了医院死亡率，即使在入院48小时内入住ICU的患者中也应评估MDRO风险因素。
