黎巴嫩医院中难以治疗的耐药铜绿假单胞菌感染：对死亡率的影响及初始抗生素治疗的作用
Difficult-to-treat resistant Pseudomonas aeruginosa infections in Lebanese hospitals: Impact on mortality and the role of initial antibiotic therapy.
作者信息
Itani Rania, Khojah Hani M J, Mukattash Tareq L, Shuhaiber Patricia, Raychouni Hamza, Dib Carole, Hassan Mariam, El-Lakany Abdalla
机构信息
Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon.
Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia.
出版信息
PLoS One. 2025 May 12;20(5):e0321935. doi: 10.1371/journal.pone.0321935. eCollection 2025.
BACKGROUND
Difficult-to-treat resistant (DTR) Pseudomonas aeruginosa infections have emerged as a significant global public health threat, characterized by limited treatment options and a heightened mortality risk. This study aimed to assess the appropriateness of initial antibiotic therapy, estimate 30-day all-cause mortality, and determine the impact of DTR P. aeruginosa infections on mortality.
METHODS
A retrospective, multicenter study was conducted at four teaching hospitals in Beirut, Lebanon, between January 2021 and December 2023. The primary outcome was 30-day all-cause mortality. Kaplan-Meier survival analysis was used to assess time-to-mortality, and the log-rank test was applied to compare survival outcomes relative to DTR infections and the appropriateness of initial antibiotic therapy. Multivariable logistic regression was performed to identify predictors of mortality.
RESULTS
Out of 2,639 screened cases, 477 patients met the inclusion criteria. Respiratory tract infections accounted for 38.8% of cases. Carbapenem-resistant P. aeruginosa (CRPA) comprised nearly one-third of isolates, and 15.3% were categorized as DTR. The most common empirical antibiotics were piperacillin-tazobactam (33.9%) and meropenem (24.5%). Inappropriate initial antibiotic therapy was observed in 43.8% of cases, with 33.8% of patients receiving antibiotics to which the pathogen was resistant. DTR infections were significantly more likely to be associated with inappropriate therapy (odds ratio [OR] = 4.21, 95% CI = 2.43-7.32, P < 0.001). The 30-day all-cause mortality rate was 14.8%, with a mean time-to-mortality of 13.29 ± 9.81 days. Patients who received inappropriate therapy had a shorter time-to-mortality (11.76 ± 8.80 days) compared to those receiving appropriate therapy (15.46 ± 10.90 days, P = 0.03). Predictors of mortality included DTR P. aeruginosa infection (adjusted odds ratio [AOR] = 2.48, 95% CI = 1.32-4.63, P < 0.01), and inappropriate initial therapy (AOR = 1.40, 95% CI = 1.04-2.35, P < 0.01).
CONCLUSION
DTR P. aeruginosa infections and inappropriate initial antibiotic therapy are associated with increased mortality risk in hospitalized patients.
背景
难治性耐药铜绿假单胞菌感染已成为全球重大公共卫生威胁，其特点是治疗选择有限且死亡风险增加。本研究旨在评估初始抗生素治疗的合理性，估计30天全因死亡率，并确定难治性耐药铜绿假单胞菌感染对死亡率的影响。
方法
2021年1月至2023年12月在黎巴嫩贝鲁特的四家教学医院进行了一项回顾性多中心研究。主要结局是30天全因死亡率。采用Kaplan-Meier生存分析评估死亡时间，并应用对数秩检验比较难治性耐药感染和初始抗生素治疗合理性的生存结局。进行多变量逻辑回归以确定死亡率的预测因素。
结果
在2639例筛查病例中，477例患者符合纳入标准。呼吸道感染占病例的38.8%。耐碳青霉烯铜绿假单胞菌（CRPA）占分离株的近三分之一，15.3%被归类为难治性耐药。最常用的经验性抗生素是哌拉西林-他唑巴坦（33.9%）和美罗培南（24.5%）。43.8%的病例观察到初始抗生素治疗不当，33.8%的患者接受了病原体耐药的抗生素。难治性耐药感染与治疗不当的相关性显著更高（比值比[OR]=4.21，95%可信区间[CI]=2.43-7.32，P<0.001）。30天全因死亡率为14.8%，平均死亡时间为13.29±9.81天。与接受适当治疗的患者（15.46±10.90天，P=0.03）相比，接受不当治疗的患者死亡时间更短（11.76±8.80天）。死亡率的预测因素包括难治性耐药铜绿假单胞菌感染（调整后比值比[AOR]=2.48，95%CI=1.32-4.63，P<0.01）和初始治疗不当（AOR=1.40，95%CI=1.04-2.35，P<0.01）。
结论
难治性耐药铜绿假单胞菌感染和初始抗生素治疗不当与住院患者死亡风险增加有关。
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