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Vancomycin-resistant enterococci bacteremia: Risk factors for mortality and influence of antimicrobial therapy on clinical outcome
VRE菌血症：死亡的危险因素以及对临床抗菌治疗结果的影响
Sang Hoon Hana, Bum Sik China, Han Sung Leea, Su Jin Jeonga, Hee Kyoung Choia, Chang Oh Kima, Dongeun Yongb, Jun Yong Choia, Young Goo Songa, Kyungwon Leeb, June Myung Kima
Accepted 28 January 2009. published online 24 February 2009.
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Summary
Objectives：This study evaluated the effects of antimicrobial treatment against vancomycin-resistant enterococci (VRE) and delayed administration of anti-VRE therapy on mortality, and determined independent risk factors for delayed all-cause mortality of VRE bacteremia patients.
Methods：Over 10 years, 153 patients with clinically significant monomicrobial VRE bacteremia were identified among a total of 2834 patients in a VRE cohort. The main outcomes were immediate (7-day) and delayed (28-day, 60-day) all-cause mortality.
Results：The 7-day (P<0.001) and 28-day (P=0.041) mortalities were lower in the group receiving anti-VRE therapy, but the 60-day mortality (P=0.113) was unaffected. The mortalities of patients receiving anti-VRE therapy later than 72h after the onset of bacteremia were no different from that of patients receiving treatment within 72h. Both a higher APACHE II score (hazard ratio [HR], 1.10; P<0.001 and HR, 1.12; P<0.001, respectively) and the presence of septic shock at the onset of bacteremia (HR, 1.91; P=0.047 and HR, 1.78; P=0.034, respectively) were independent risk factors for 28-day and 60-day mortality.
Conclusion：These findings suggest that in spite of antibiotic therapy against VRE, patients with VRE bacteremia eventually have a higher risk of death because of severe illness at the onset of bacteremia.
Keywords: Vancomycin-resistant enterococci, Bacteremia, Mortality
[ 本帖最后由 临海听涛 于 2009-3-1 10:36 编辑 ] |
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发表于 2009-3-1 10:30
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发表于 2009-3-1 17:12