Krcméry V, Spanik S, Krupova I, Trupl J, Kunova A, Smid M, Pichnova E
Dept. of Medicine and Oncology, Dept. of Public Health and Social Care, University of Trnava, School of Public Health, Slovakia.
J Chemother. 1998 Aug;10(4):320-5. doi: 10.1179/joc.1998.10.4.320.
The aim of this study was to see if multiresistant Gram-negative bacteremias (MRGNB) are associated with specific risk factors and/or higher mortality in comparison to sensitive GNB (SGNB). Both groups, 51 patients and 102 controls, were matched for sex, age, underlying disease and neutropenia. In addition there were no significant differences in the incidence of cytotoxic chemotherapy administered, vascular catheter insertion and catheter as source of bacteremia and etiology of bacteremia. The proportion of Klebsiella-Enterobacter, Pseudomonas aeruginosa, Acinetobacter spp. and Stenotrophomonas maltophilia was similar in both groups. Prior surgery (21.6% vs 7.6%, p<0.02) was significantly associated with SGNB. Previous prophylaxis with quinolones (45.1% vs 24.5%, p<0.045), and prior therapy with broad spectrum antibiotics (41.2% vs 27.5%, p<0.05) were significantly more frequently observed among patients than controls. Patients with bacteremia due to MRGNB were also significantly more frequently infected with resistant bacteria. Attributable mortality was similar (15.7% vs 13.75%, NS) in both groups, however cure rates were lower among MRGNB patients. Crude mortality was higher among patients (35.3% vs 13.75%, p<0.01) in comparison to controls. In conclusion, prior antimicrobial prophylaxis and therapy with several classes of antimicrobials represents a significant risk for development of resistance. Mortality due to multiresistant Gram-negative bacteremias was higher in comparison to bacteremias due to susceptible organisms.
本研究的目的是探究多重耐药革兰氏阴性菌血症（MRGNB）与敏感革兰氏阴性菌血症（SGNB）相比，是否与特定风险因素和/或更高的死亡率相关。两组，51例患者和102例对照，在性别、年龄、基础疾病和中性粒细胞减少方面进行了匹配。此外，在细胞毒性化疗的发生率、血管导管插入、作为菌血症来源的导管以及菌血症的病因方面没有显著差异。两组中克雷伯菌属-肠杆菌属、铜绿假单胞菌、不动杆菌属和嗜麦芽窄食单胞菌的比例相似。既往手术（21.6%对7.6%，p<0.02）与SGNB显著相关。患者比对照组更频繁地观察到先前使用喹诺酮类药物进行预防（45.1%对24.5%，p<0.045），以及先前使用广谱抗生素进行治疗（41.2%对27.5%，p<0.05）。因MRGNB导致菌血症的患者也更频繁地感染耐药菌。两组的归因死亡率相似（15.7%对13.75%，无显著性差异），然而MRGNB患者的治愈率较低。与对照组相比，患者的粗死亡率更高（35.3%对13.75%，p<0.01）。总之，先前使用几类抗菌药物进行抗菌预防和治疗是产生耐药性的重大风险。与易感菌引起的菌血症相比，多重耐药革兰氏阴性菌血症导致的死亡率更高。
