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Clin Infect Dis :经验性抗生素治疗耐碳青霉烯类革兰氏阴性菌致严重感染与死亡率之间的关联:一项前瞻性研究

发布日期:2018-12-02来源:Clinical Infectious Diseases发布人:感控雏鹰

摘要

背景

应避免经验性使用粘菌素。我们的目的旨在评估覆盖经验性抗生素使用(EAT)与耐碳青霉烯革兰氏阴性菌(CRGNB)引起的感染死亡率之间的关联。

方法

这是一项随机对照试验的二次分析,包括由耐碳青霉烯革兰氏阴性菌引起的血流感染,肺炎或尿脓毒症的成人。所有患者均接受覆盖经验性抗生素使用,然后进行靶向治疗。暴露变量在最初的48小时内覆盖了覆盖经验性抗生素使用。结果是28天死亡率。我们通过多变量回归分析和倾向得分匹配来调整分析。

结果

该研究包括406名患有严重耐碳青霉烯革兰氏阴性菌感染的住院患者,其中大多数是鲍曼不动杆菌312/406 [77])。覆盖经验性抗生素使用的患者为209例(51.5%),多为粘菌素(n = 200)。接受非覆盖性经验性抗生素使用的患者年龄较大,更常失去意识和依赖性,携带导管,并通过机械通气治疗肺炎。死亡率为19784.6%)中的84,其中非覆盖率为209,其中96%(45.9%)覆盖经验性抗生素使用(P= .504)。在调整后的分析中,覆盖经验性抗生素使用与生存无关相反,与死亡率的关联性较弱(优势比[OR]1.37; 95%置信区间[CI]1.02-1.84)。粘菌素单一疗法和粘菌素 - 碳青霉烯组合覆盖经验性抗生素使用的结果相似。在倾向评分匹配的队列(n = 338)中,覆盖抗生素与死亡率无显着相关性(OR1.42; 95CI.91-2.22)。在14天死亡率分析中获得了类似的结果。

结论

在有或没有碳青霉烯的病原体鉴定之前对粘菌素的经验使用与耐碳青霉烯革兰氏阴性菌(主要是鲍氏不动杆菌)引起的严重感染后的存活率无关。


The Association Between Empirical Antibiotic Treatment and Mortality in Severe Infections Caused by Carbapenem-resistant Gram-negative Bacteria: A Prospective Study

ABSTRACT

Background

Empirical colistin should be avoided. We aimed to evaluate the association between covering empirical antibiotics (EAT) and mortality for infections caused by carbapenem-resistant gram-negative bacteria (CRGNB).

Methods

This was a secondary analysis of a randomized controlled trial, including adults with bloodstream infections, pneumonia, or urosepsis caused by CRGNB. All patients received EAT followed by covering targeted therapy. The exposure variable was covering EAT in the first 48 hours. The outcome was 28-day mortality. We adjusted the analyses by multivariable regression analysis and propensity score matching.

Results

The study included 406 inpatients with severe CRGNB infections, mostly Acinetobacter baumannii (312/406 [77%]). Covering EAT was given to 209 (51.5%) patients, mostly colistin (n = 200). Patients receiving noncovering EAT were older, more frequently unconscious and dependent, carrying catheters, and mechanically ventilated with pneumonia. Mortality was 84 of 197 (42.6%) with noncovering vs 96 of 209 (45.9%) with covering EAT (P = .504). Covering EAT was not associated with survival in the adjusted analysis; rather, there was a weak association with mortality (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.02–1.84). Results were similar for colistin monotherapy and colistin-carbapenem combination EAT. In the propensity score–matched cohort (n = 338) covering antibiotics were not significantly associated with mortality (OR, 1.42; 95% CI, .91–2.22). Similar results were obtained in an analysis of 14-day mortality.

Conclusions

Empirical use of colistin before pathogen identification, with or without a carbapenem, was not associated with survival following severe infections caused by CRGNBs, mainly A. baumannii.

Clinical Infectious Diseases, Volume 67, Issue 12, 28 November 2018, Pages 1815–1823, https://doi.org/10.1093/cid/ciy371

简译人:感控雏鹰