复杂感染中的抗菌药物敏感性谱及死亡的关键决定因素
Antimicrobial Susceptibility Profiles and Key Determinants for Mortality in Complex Infections.
作者信息
Özdemir Yusuf Emre, Kaplan-Yapar Beyza, Borcak Deniz, Canbolat-Ünlü Esra, Bayramlar Osman Faruk, Çizmeci Zeynep, Kart-Yaşar Kadriye
机构信息
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Türkiye.
Department of Public Health, Bakırköy District Health Directorate, İstanbul, Türkiye.
出版信息
Infect Dis Clin Microbiol. 2023 Sep 30;5(3):239-250. doi: 10.36519/idcm.2023.259. eCollection 2023 Sep.
OBJECTIVE
We aimed to define the clinical features and antimicrobial susceptibility profiles of complex infections and to determine the predictors for mortality.
MATERIALS AND METHODS
Our single-center retrospective study included patients with nosocomial complex infection between 2018 and 2022. We evaluated the predictors of 14-day and 28-day mortality by analyzing clinical and microbiological data.
RESULTS
A total of 87 patients were included. Most infections (79.3%) occurred in the intensive care units (ICUs). Among complex isolates, 74.7% were susceptible to trimethoprim-sulfamethoxazole, 70.3% to levofloxacin, 50% to meropenem, and 23.4% to ceftazidime. The rates of 14-day mortality, 28-day mortality, and in-hospital mortality were 41.3% (n=36), 52.8% (n=46), and 64.3% (n=56), respectively. Multivariate analysis revealed neutrophil/lymphocyte ratio (NLR) (odds ratio [OR]=1.05, =0.024), platelet count (OR=1.00, =0.011), creatinine (OR=2.14, =0.006), and aspartate aminotransferase (AST) (OR=1.02, =0.028) as predictors for 14-day mortality. In addition to NLR (OR=1.07, =0.014), platelet count (OR=1.00, =0.039), creatinine (OR=2.05, =0.008), and AST (OR=1.02, =0.035), procalcitonin (OR=1.05, =0.049) was also found as an independent predictor for 28-day mortality. In receiver operating characteristic (ROC) curve analysis for predicting 14-day mortality, area under the ROC curve (AUC) values were 0.684 (=0.003) in NLR, 0.719 (<0.001) in platelet count, 0.673 (=0.003) in procalcitonin, 0.743 (<0.001) in creatinine, and 0.700 (<0.001) in AST. In ROC curve analysis for predicting 28-day mortality, AUC values were 0.674 (=0.002) in NLR, 0.651 (=0.010) in platelet count, 0.638 (=0.020) in procalcitonin, 0.730 (<0.001) in creatinine, and 0.692 (=0.001) in AST.
CONCLUSION
Increasing antibiotic resistance and higher mortality rates justify that complex is a significant threat to hospitalized patients, especially in ICUs. Elevated levels of NLR, AST, creatinine, procalcitonin, and decreased platelet may predict poor clinical outcomes and could help clinicians in the management of this notorious bacterial pathogen.
目的
我们旨在明确复杂感染的临床特征和抗菌药物敏感性谱，并确定死亡率的预测因素。
材料与方法
我们的单中心回顾性研究纳入了2018年至2022年间发生医院获得性复杂感染的患者。我们通过分析临床和微生物学数据评估了14天和28天死亡率的预测因素。
结果
共纳入87例患者。大多数感染（79.3%）发生在重症监护病房（ICU）。在复杂分离株中，74.7%对复方磺胺甲恶唑敏感，70.3%对左氧氟沙星敏感，50%对美罗培南敏感，23.4%对头孢他啶敏感。14天死亡率、28天死亡率和住院死亡率分别为41.3%（n = 36）、52.8%（n = 46）和64.3%（n = 56）。多因素分析显示中性粒细胞/淋巴细胞比值（NLR）（比值比[OR]=1.05，P = 0.024）、血小板计数（OR = 1.00，P = 0.011）、肌酐（OR = 2.14，P = 0.006）和天门冬氨酸氨基转移酶（AST）（OR = 1.02，P = 0.028）是14天死亡率的预测因素。除NLR（OR = 1.07，P = 0.014）、血小板计数（OR = 1.00，P = 0.039）、肌酐（OR = 2.05，P = 0.008）和AST（OR = 1.02，P = 0.035）外，降钙素原（OR = 1.05，P = 0.049）也被发现是28天死亡率的独立预测因素。在预测14天死亡率的受试者工作特征（ROC）曲线分析中，NLR的ROC曲线下面积（AUC）值为0.684（P = 0.003），血小板计数为0.719（P < 0.001），降钙素原为0.673（P = 0.003），肌酐为0.743（P < 0.001），AST为0.700（P < 0.001）。在预测28天死亡率的ROC曲线分析中，NLR的AUC值为0.674（P = 0.002），血小板计数为0.651（P = 0.010），降钙素原为0.638（P = 0.020），肌酐为0.730（P < 0.001），AST为0.692（P = 0.001）。
结论
抗生素耐药性增加和较高的死亡率表明复杂感染是住院患者尤其是ICU患者的重大威胁。NLR、AST、肌酐、降钙素原水平升高和血小板减少可能预示临床预后不良，并有助于临床医生管理这种难治性细菌病原体。
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