耐万古霉素、耐甲氧西林的[此处原文不完整，缺内容]定植与脓毒症死亡率之间是否存在关联？
Is there an association between colonisation of vancomycin resistant , methicillin resistant , or and mortality in sepsis?
作者信息
Sigakis Matthew Jg, Posluszny Joseph, Maile Michael D, Jewell Elizabeth S, Engoren Milo
机构信息
Department of Anesthesiology, University of Michigan, Ann Arbor, USA.
Department of Surgery, Case Western Reserve University, Cleveland, USA.
出版信息
Infect Prev Pract. 2024 Oct 26;6(4):100413. doi: 10.1016/j.infpip.2024.100413. eCollection 2024 Dec.
BACKGROUND
To determine if colonisation with drug resistant organisms is associated with worse outcomes in patients who subsequently develop sepsis.
METHODS
Retrospective study of patients with sepsis employing logistic regression and linear regression to determine the independent association of colonisation with adverse outcomes.
RESULTS
Mortality was higher in patients colonized with VRE [501 of 1937 (26%) v. 1052 of 5624 (19%) non-VRE colonised patients, difference 7% (95% confidence interval (5,9%), p<0.001] and MRSA [168 of 708 (24%) v 1342 of 6804 (20%) non-MRSA colonised patients, difference 4% (1,7%), p = 0.014]. CDiff colonisation was not associated with increased mortality [153 of 757 (21%) v 762 of 7432 (18%), difference 3% (0,6%), p=0.052]. After multivariable logistic regression, VRE colonisation remained associated with increased hospital mortality [odds ratio = 1.273, 95% confidence interval (1.099, 1.475), p = 0.001]. VRE colonisation was also associated with subsequent receipt of mechanical ventilation [odds ratio = 1.179, 95% confidence interval (1.043, 1.334), p = 0.009] and with receipt of renal replacement therapy (RRT) [OR = 1.36 (1.11, 1.66), p = 0.003].
CONCLUSIONS
We found that VRE colonisation, but not MRSA or C. diff colonisation, was associated with increased hospital mortality in septic patients.
背景
确定耐药菌定植是否与随后发生脓毒症的患者预后较差相关。
方法
对脓毒症患者进行回顾性研究，采用逻辑回归和线性回归来确定定植与不良结局之间的独立关联。
结果
VRE定植患者的死亡率更高[1937例中有501例（26%），非VRE定植患者5624例中有1052例（19%），差异7%（95%置信区间（5,9%），p<0.001]，MRSA定植患者也是如此[708例中有168例（24%），非MRSA定植患者6804例中有1342例（20%），差异4%（1,7%），p = 0.014]。艰难梭菌定植与死亡率增加无关[757例中有153例（21%），7432例中有762例（18%），差异3%（0,6%），p = 0.052]。多变量逻辑回归后，VRE定植仍与医院死亡率增加相关[比值比 = 1.273，95%置信区间（1.099, 1.475），p = 0.001]。VRE定植还与随后接受机械通气[比值比 = （1.179, 95%置信区间（1.043, 1.334），p = 0.009]和接受肾脏替代治疗（RRT）[比值比 = 1.36（1.11, 1.66），p = 0.003]相关。
结论
我们发现，VRE定植而非MRSA或艰难梭菌定植与脓毒症患者医院死亡率增加相关。
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