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本帖最后由 蓝鱼o_0 于 2012-8-31 10:06 编辑
Yi-Tzu Lee. Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Chutung Veterans Hospital, Hsinchu County, Taiwan; and Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan
Corresponding author: Te-Li Chen
Mailing address: Division of Infectious Diseases, Taipei Veterans General Hospital,
No. 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan.
Phone: +886-2-28757494.
Fax: +886-2-28730052.
E-mail: tlchen@vghtpe.gov.tw
Background. The efficacy of antimicrobial therapy for Acinetobacter baumannii
bacteremia has been difficult to establish because of confounding by underlying
diseases, severity of infection and differences in the pathogenicity of Acinetobacter
species. This retrospective study was conducted to evaluate the effect of appropriate
antimicrobial therapy on 14-day mortality after adjustment for multiple risk factors.Methods. The population consisted of 252 patients with monomicrobial A. baumannii
bacteremia admitted to a large teaching hospital in Taiwan. The isolates were
identified to species level using reference molecular methods. Predictors of 14-day
mortality were determined by logistic regression analysis. The influence of severity of
infection, determined by Acute Physiology and Chronic Health Evaluation (APACHE)
II score, on the impact of appropriate use of antimicrobials on 14-day mortality was
assessed by including an interaction term.
Results. The overall 14-day mortality was 75/252 (29.8%). The unadjusted mortality
for appropriate antimicrobial therapy was 12/91 (13.2%). Appropriate therapy was
independently associated with reduced mortality (odds ratio [OR], 0.22; 95%
confidence interval [CI], 0.01-0.50; P < .001), and the effect was influenced by
APACHE II score (OR for interaction term, 0.90; 95% CI, 0.82-0.98; P = .02).
Subgroup analysis revealed that the benefit of appropriate therapy limited to patients
with high APACHE II scores (for scores > 25 and ≤ 35, OR, 0.16; 95% CI, 0.07-0.37
and for scores >35, OR, 0.06; 95% CI, 0.01-0.25).
Conclusions. Appropriate antimicrobial therapy significantly reduced 14-day
mortality for A. baumannii bacteremia in severely ill patients.
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发表于 2012-8-31 10:04
发表于 2012-8-31 10:21
