Edmond M B, Ober J F, Dawson J D, Weinbaum D L, Wenzel R P
Division of Quality Health Care, Medical College of Virginia Commonwealth University, Richmond 23298-0509, USA.
Clin Infect Dis. 1996 Dec;23(6):1234-9. doi: 10.1093/clinids/23.6.1234.
Previous studies have shown that bacteremia due to vancomycin-resistant Enterococcus species (VRE) is associated with mortality of 17%-100%, but comorbid conditions may have confounded the estimates. We designed a historical cohort study to determine the mortality attributable to VRE bacteremia. Twenty-seven patients with VRE bacteremia were identified as cases. Within 7 days of the onset of bacteremia, severe sepsis developed in 12 patients (44%) and septic shock developed in 10 (37%). Case patients were closely matched to control patients without VRE bacteremia (1:1) by time of hospitalization, duration of exposure, underlying disease, age, gender, and surgical procedure. The mortality was 67% among cases and 30% among matched controls (P = 0.1). Thus, the mortality attributable to VRE bacteremia was 37% (95% confidence interval [CI], 10%-64%) and the risk ratio for death was 2.3 [CI, 1.2-4.1). We conclude that VRE bacteremia is associated with high rates of severe sepsis and septic shock. The attributable mortality approaches 40%, and patients who have VRE bacteremia are twice as likely to die than closely matched controls.
既往研究表明，耐万古霉素肠球菌（VRE）所致菌血症的死亡率为17% - 100%，但合并症可能使这些估计值产生混淆。我们设计了一项历史性队列研究，以确定VRE菌血症所致的死亡率。确定了27例VRE菌血症患者作为病例。在菌血症发作的7天内，12例患者（44%）发生了严重脓毒症，10例患者（37%）发生了感染性休克。病例患者与无VRE菌血症的对照患者在住院时间、暴露时长、基础疾病、年龄、性别和手术操作方面进行了密切匹配（1:1）。病例组的死亡率为67%，匹配对照组的死亡率为30%（P = 0.1）。因此，VRE菌血症所致的死亡率为37%（95%置信区间[CI]，10% - 64%），死亡风险比为2.3[CI，1.2 - 4.1]。我们得出结论，VRE菌血症与严重脓毒症和感染性休克的高发生率相关。可归因死亡率接近40%，发生VRE菌血症的患者死亡可能性是密切匹配对照组的两倍。
