Vivo Amanda, Fitzpatrick Margaret A, Suda Katie J, Wilson Geneva M, Jones Makoto M, Evans Martin E, Evans Charlesnika T
Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Medical Center, Hines, IL, USA.
Center of Innovation for Veteran Centered and Value Drive Care, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA.
Antimicrob Steward Healthc Epidemiol. 2023 Dec 12;3(1):e230. doi: 10.1017/ash.2023.500. eCollection 2023.
To describe antimicrobial therapy used for multidrug-resistant (MDR) bacteremia in Veterans and impacts on mortality.
This was a retrospective cohort study of hospitalized Veterans Affairs patients from 2012 to 2018 with a positive MDR blood culture who received antimicrobial treatment 2 days prior to through 5 days after the culture date. Only the first culture per patient was used. The association between treatment and patient characteristics was assessed using bivariate analyses. Multivariable logistic regression models examined the relationship between antibiotic regimen and in-hospital, 30-day, and 1-year mortality. Generalized linear models were used to assess cost outcomes.
MDR was identified in 184 patients. Most cultures identified were , 3% were and 7% were other Penicillins-β-lactamase inhibitor combinations (51.1%) and carbapenems (51.6%)-were the most prescribed antibiotics. In unadjusted analysis, extended spectrum cephalosporins and penicillins-β-lactamase inhibitor combinations-were associated with a decreased odds of 30-day mortality but were insignificant after adjustment (adjusted odds ratio (aOR) = 0.47, 95% CI, 0.21-1.05, aOR = 0.75, 95% CI, 0.37-1.53). There was no association between combination therapy vs monotherapy and 30-day mortality (aOR = 1.55, 95% CI, 0.72-3.32).
In hospitalized Veterans with MDR ., none of the treatments were shown to be associated with in-hospital, 30-day, and 1-year mortality. Combination therapy was not associated with decreased mortality for MDR bacteremia.
描述退伍军人中用于多重耐药（MDR）菌血症的抗菌治疗及其对死亡率的影响。
这是一项对2012年至2018年住院的退伍军人事务部患者进行的回顾性队列研究，这些患者的MDR血培养呈阳性，且在培养日期前2天至培养日期后5天接受了抗菌治疗。每位患者仅使用第一次培养结果。采用双变量分析评估治疗与患者特征之间的关联。多变量逻辑回归模型检验了抗生素治疗方案与住院、30天和1年死亡率之间的关系。使用广义线性模型评估成本结果。
184例患者被鉴定为MDR。鉴定出的大多数培养物为 ，3%为 ，7%为其他 青霉素-β-内酰胺酶抑制剂组合（51.1%）和碳青霉烯类（51.6%）是最常用的抗生素。在未调整分析中，广谱头孢菌素和青霉素-β-内酰胺酶抑制剂组合与30天死亡率降低的几率相关，但调整后无统计学意义（调整后的优势比（aOR）=0.47，95%置信区间，0.21-1.05，aOR = 0.75，95%置信区间，0.37-1.53）。联合治疗与单药治疗与30天死亡率之间无关联（aOR = 1.55，95%置信区间，0.72-3.32）。
在患有MDR 的住院退伍军人中，没有一种治疗方法显示与住院、30天和1年死亡率相关。联合治疗与MDR菌血症死亡率降低无关。
