多重耐药细菌所引起的死亡率的权威数据？

细菌耐药

Jpn J Infect Dis. 2012 Jan;65(1):66-71.
Mortality Attributable to Carbapenem-Resistant Nosocomial Acinetobacter baumannii Infections in a Turkish University Hospital.

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细菌耐药

Multidrug and carbapenem-resistant Acinetobacter baumannii infections: Factors associated with mortality.
Hernández-Torres A, García-Vázquez E, Gómez J, Canteras M, Ruiz J, Yagüe G.
SourceServices of Internal Medicine-Infectious Diseases, University Hospital Virgen de la Arrixaca, Spain.

Abstract
BACKGROUND AND OBJECTIVE: To analyse factors related to mortality and influence of antibiotic treatment on outcome in patients with nosocomial infection due to multidrug and carbapenem-resistant Acinetobacter baumannii (MDR-C AB).

PATIENTS AND METHODS: Observational and prospective study of a cohort of adult patients with MDR-C AB infection. Data collection from clinical records was done according to a standard protocol (January 2007 through June 2008). Patients with MDR-C AB infection were identified by review of results of microbiology cultures from the hospital microbiology laboratory. Epidemiological and clinical variables and predictors of mortality were analysed.

RESULTS: 24 out of 101 cases were considered colonizations and 77 infections (27 bacteraemia); global mortality in infected patients was 49% (18 cases with bacteraemia and 20 with no bacteraemia). In the multivariate analysis, including the 77 cases of infection, the prognosis factors associated with mortality were age (OR 1.09; 95% CI 1.02-1.2), McCabe 1 (OR 33.98; 95% CI 4.33-266.85), bacteraemia (OR 9.89; 95% CI 1.13-86.13), inadequate empiric treatment (OR 16.7; 95% CI 2.15-129.79), and inadequate definitive treatment (OR 26.29; 95% CI 1.45-478.19). In the multivariate analysis including the 57 cases of infection with adequate definitive treatment, the prognosis factors associated with mortality were McCabe 1 (OR 24.08; 95% CI 3.67-157.96) and monotherapy versus combined treatment (OR 7.11; 95% CI 1.63-30.99).

CONCLUSIONS: Our cohort of patients with MDR-C AB infection is characterised by a very high mortality (49%);the severity of patients and inadequate treatment or monotherapy are statistically associated with mortality.

这篇文章报道的：多重耐药不动引起的死亡高达49%。

细菌耐药

本帖最后由 细菌耐药 于 2012-2-23 11:00 编辑

J Crit Care. 2011 Oct;26(5):526-7.
Multidrug-resistant Acinetobacter baumannii infection is not an independent risk factor for mortality in critically ill patients with hematologic malignancy.
Turkoglu M, Dizbay M.

这篇文章提出，多重耐药不是死亡的独立危险因素，我想，该评价是客观的。








PIIS0883944111003960.pdf



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细菌耐药

J Formos Med Assoc. 2011 Sep;110(9):564-71. doi: 10.1016/j.jfma.2011.07.004.
Mortality risk factors in patients with Acinetobacter baumannii ventilator: associated pneumonia.
Chang HC, Chen YC, Lin MC, Liu SF, Chung YH, Su MC, Fang WF, Tseng CC, Lie CH, Huang KT, Wang CC.
SourceDivision of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital- Kaohsiung Medical Center, Chang Gung University College of Medicine, Taiwan. ccwang52@adm.cgmh.org.tw

Abstract
BACKGROUND/PURPOSE: Ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii has contributed to high mortality rate, prolonged stays in the intensive care unit, and the rapid development of antimicrobial resistance to commonly used antimicrobials. This study sought to determine predictors of mortality and carbapenem resistance for patients with A baumannii VAP.

METHODS: We retrospectively reviewed 541 adult patients with A baumannii pneumonia, who were admitted to a medical center between 2005 and 2007; of which 180 (33.3%) had been treated with mechanical ventilation. Of the 180 patients, 98 (54.4%) who survived were categorized as the survivor group, and 82 (45.6%) who died as the mortality group. Eighty-seven (48.3%) with imipenem-sensitive A baumannii VAP were categorized as the IS-AB group, and the remaining 93 (51.7%) with imipenem-resistant VAP as the IR-AB group.

RESULTS: Compared with the survivor group, the mortality group had significantly higher Charlson comorbidity index scores, and more neoplastic disease, other sites of infection, bloodstream infections, altered mental status, confusion, urea >7 mmol/L, respiratory rate >30/min, low blood pressure (systolic  1.6 mg/dL, C-reactive protein ≥ 100 mg/L, and imipenem resistance. The survivor group had more cases of tracheostomy and diabetes mellitus than the mortality group had. Compared with the IS-AB group, the IR-AB group had higher Charlson comorbidity index scores, longer stays before VAP onset, an increase in other sites of infection, white blood cell count 1.1 × 10(4)/μL, and higher hospital mortality rates.

CONCLUSION: Inadequate initial empiric antimicrobial therapy and higher disease severity scores, including CURB ≥ 3 and C-reactive protein ≥ 120 mg/L, were independent risk factors associated with higher mortality rates for A baumannii pneumonia. Length of stay before VAP and white blood cell count 1.1 × 10(4)/μL were independent risk factors for carbapenem resistance.

Copyright © 2011. Published by Elsevier B.V.










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细菌耐药

J Med Assoc Thai. 2009 Mar;92(3):413-9.
Attributable mortality of imipenem-resistant nosocomial Acinetobacter baumannii bloodstream infection.
Jamulitrat S, Arunpan P, Phainuphong P.
SourceDepartment of Community Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. jsilom@medicine.psu.ac.th

Abstract
BACKGROUND: Uncertainty remains concerning the mortality attributable to infections caused by imipenem-resistant acinetobacter baumannii (IRAB). The authors have sought to examine the impact of this resistance on patient mortality.

OBJECTIVE: To evaluate the effects of imipenem resistance on the mortality of patients with Acinetobacter baumannii bloodstream infection.

MATERIAL AND METHOD: A cohort study was conducted to compare the survival rates between patients with IRAB and imipenem-susceptible A. baumannii (ISAB) bacteremia.

RESULTS:The present study shows 35 patients (52.2%) in an IRAB group died in hospital compared to 26 patients (19.9%) in an ISAB group (p < 0.001). Multivariate analysis using Cox's proportional hazard model for controlling the confounding effects due to the severity of underlying diseases, inappropriate antibiotic treatment, and primary source of bacteremia show no statistically significant difference in mortality rates between the two groups.

CONCLUSION: The observed higher mortality rate among patients with an IRAB bloodstream infection may not be attributable to imipenem resistance but may in some part be due to a more severe illness, inappropriate antimicrobial therapy, and primary source of infection.

细菌耐药

J Microbiol Immunol Infect. 2008 Oct;41(5):397-402.
Risk factors for mortality in patients with Acinetobacter baumannii bloodstream infection with genotypic species identification.
Chiang DH, Wang CC, Kuo HY, Chen HP, Chen TL, Wang FD, Cho WL, Liu CY.
SourceDepartment of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Abstract
BACKGROUND AND PURPOSE: Acinetobacter baumannii is an increasingly common nosocomial infection with a high mortality rate. Identification of predictor factors of mortality from A. baumannii infection is important for the implementation of therapeutic management for patients with higher risk. However, many studies have reported data for Acinetobacter calcoaceticus-A. baumannii complex, which might lead to an uncertainty of results. In this study, we aimed to identify the predictive factors for mortality of patients infected with true A. baumannii that had been precisely identified by genotypic methodology.

METHODS: Sixty seven patients with documented A. baumannii bacteremia were identified from a medical center in northern Taiwan during the period between February 1998 and February 2001. The patients' medical records were retrospectively reviewed.

RESULTS: The risk factors associated with mortality in patients with A. baumannii bacteremia were underlying disease with malignancy, end-stage renal disease, and inappropriate antibiotic therapy. Laboratory variables, such as creatinine level, were also associated with poor prognosis by multivariate analysis.

CONCLUSIONS:Increased serum creatinine level, malignancy and inappropriate therapy within 3 days were related to increased mortality in patients with A. baumannii bloodstream infection. Physicians should be aware of patients with poor prognostic factors and initiate prompt strategies, including appropriate antimicrobial therapy, in order to reduce mortality.

细菌耐药

Colonization or Infection with Multidrug-Resistant Acinetobacter baumannii May Be an Independent Risk Factor for Increased Mortality Effrossyni Gkrania-Klotsas1 and Ronald C. Hershow2
+ Author Affiliations
1Infectious Diseases Department, Addenbrooke's Hospital, Cambridge, United Kingdom
2Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Illinois
Reprints or correspondence: Dr. Effrossyni Gkrania-Klotsas, Infectious Diseases Dept., Box 25/Ward D10, Addenbrooke's Hospital, University of Cambridge Teaching Hospital NHS Trust, Cambridge, CB2 2QQ, United Kingdom (egkraniaklotsas@nhs.net).
We read with great interest the article by Fournier and Richet [1], and we noted the correspondence by Falagas et al. [2]. During an epidemic of multidrug-resistant (MDR) Acinetobacter baumannii colonization and infection in a Chicago teaching hospital (University of Illinois at Chicago Medical Center) [3], we conducted a retrospective case-control study comparing all patients who were colonized or infected with MDR A. baumannii with all patients who were colonized or infected with MDR Pseudomonas aeruginosa from the same year; 78 MDR A. baumanii and 112 MDR P. aeruginosa isolates were included. Between these 2 groups, statistically different parameters from the univariate analysis included the number of days that a urinary catheter was in place, the number of days that an intravascular catheter was in place, the number of mechanical ventilation days, length of stay in an intensive care unit, transplantation status, and use of third-generation cephalosporins, trimethoprim, vancomycin, or fluoroquinolones during the 14 days before a clinical specimen culture was positive. Kaplan-Meier analysis showed a significantly increased mortality in the A. baumannii group, even after adjusting for stay in an intensive care unit (P = .0002).
With the above-mentioned limitations in mind, we believe that colonization or infection with MDR A. baumannii may be an independent risk factor for increased mortality.

细菌耐药

Then I go on to search the papars focus on multidrug resistance of Pseudomonas aeruginosa (多重耐药铜绿假单胞菌)

Intern Med. 2012;51(1):59-64. Epub 2012 Jan 1.
Clinical characteristics and risk factors for mortality in patients with bacteremia caused by Pseudomonas aeruginosa.
Horino T, Chiba A, Kawano S, Kato T, Sato F, Maruyama Y, Nakazawa Y, Yoshikawa K, Yoshida M, Hori S.
SourceDepartment of Infectious Disease and Infection Control, The Jikei University School of Medicine, Japan. horino@jikei.ac.jp

Abstract
OBJECTIVE: The mortality rates for bacteremia due to Pseudomonas aeruginosa remain high. In our hospital, we performed retrospective analyses to determine risk factors for mortality among patients with bacteremia caused by P. aeruginosa.

MATERIALS AND METHODS: This retrospective cohort study was conducted among adult patients with bacteremia due to P. aeruginosa at Jikei University Hospital. We analyzed factors, such as age, gender, underlying disease, initial antimicrobial treatment, and primary site of infection to determine which of these were predictive of mortality in patients with P. aeruginosa bacteremia.

RESULTS: One hundred and thirty-four patients with P. aeruginosa bacteremia were identified between April 2003 and March 2010. The 30-day mortality rate among all patients with P. aeruginosa bacteremia was 20.9%. The most common underlying disease was leukemia (20.9%), and the most common primary site of infection was the urinary tract (24.6%). Seventy-one patients (65.7%) were treated with an appropriate initial antimicrobial regimen for P. aeruginosa bacteremia. However, these patients had similar 30-day mortality to that observed in patients not administered appropriate antibiotics. This study revealed that risk factors for the 30-day mortality were thrombocytopenia and polymicrobial P. aeruginosa bacteremia (p

细菌耐药

Antimicrob Agents Chemother. 2012 Mar;56(3):1265-1272. Epub 2011 Dec 12.
Prospective Multicenter Study of the Impact of Carbapenem Resistance on Mortality in Pseudomonas aeruginosa Bloodstream Infections.
Peña C, Suarez C, Gozalo M, Murillas J, Almirante B, Pomar V, Aguilar M, Granados A, Calbo E, Rodríguez-Baño J, Rodríguez F, Tubau F, Martínez-Martínez L, Oliver A; for the Spanish Network for Research in Infectious Diseases (REIPI).
SourceAddress correspondence to Carmen Peña, cpena@bellvitgehospital.cat.

Abstract
The impact of antimicrobial resistance on clinical outcomes is the subject of ongoing investigations, although uncertainty remains about its contribution to mortality. We investigated the impact of carbapenem resistance on mortality in Pseudomonas aeruginosa bacteremia in a prospective multicenter (10 teaching hospitals) observational study of patients with monomicrobial bacteremia followed up for 30 days after the onset of bacteremia. The adjusted influence of carbapenem resistance on mortality was studied by using Cox regression analysis. Of 632 episodes, 487 (77%) were caused by carbapenem-susceptible P. aeruginosa (CSPA) isolates, and 145 (23%) were caused by carbapenem-resistant P. aeruginosa (CRPA) isolates. The median incidence density of nosocomial CRPA bacteremia was 2.3 episodes per 100,000 patient-days (95% confidence interval [CI], 1.9 to 2.8). The regression demonstrated a time-dependent effect of carbapenem resistance on mortality as well as a significant interaction with the Charlson index: the deleterious effect of carbapenem resistance on mortality decreased with higher Charlson index scores. The impact of resistance on mortality was statistically significant only from the fifth day after the onset of the bacteremia, reaching its peak values at day 30 (adjusted hazard ratio for a Charlson score of 0 at day 30, 9.9 [95% CI, 3.3 to 29.4]; adjusted hazard ratio for a Charlson score of 5 at day 30, 2.6 [95% CI, 0.8 to 8]). This study clarifies the relationship between carbapenem resistance and mortality in patients with P. aeruginosa bacteremia. Although resistance was associated with a higher risk of mortality, the study suggested that this deleterious effect may not be as great during the first days of the bacteremia or in the presence of comorbidities.

细菌耐药

Mortality.The 30-day mortality cumulative incidence rates were 27% for the CSPA group (132 of 487 patients) and 35% for the CRPA group (51 of 145 patients). Figure 2 shows the 30-day survival curves and a comparison between the groups (P = 0.10). Although the mortality rates were similar for the groups at the end of the first 72 h (63 [13%] patients in the CSPA group died, versus 17 [12%] in the CRPA group [P = 0.7]), the Kaplan-Meier survival curves (Fig. 2) showed a higher mortality rate for the CSPA group in the first 2 days than for the CRPA group (12% versus 7% [the P value was not significant]).
















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