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本帖最后由 蓝鱼o_0 于 2012-6-21 17:22 编辑
Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European
intensive-care units: a cohort study
Marie-Laurence Lambert, Carl Suetens, Anne Savey, Mercedes Palomar, Michael Hiesmayr, Ingrid Morales, Antonella Agodi, Uwe Frank,
Karl Mertens, Martin Schumacher, Martin Wolkewitz
Summary
Background Patients admitted to intensive-care units are at high risk of health-care-associated infections, and many
are caused by antimicrobial-resistant pathogens. We aimed to assess excess mortality and length of stay in intensivecare
units from bloodstream infections and pneumonia.
Methods We analysed data collected prospectively from intensive-care units that reported according to the European
standard protocol for surveillance of health-care-associated infections. We focused on the most frequent causative
microorganisms. Resistance was defi ned as resistance to ceftazidime (Acinetobacter baumannii or Pseudomonas
aeruginosa), third-generation cephalosporins (Escherichia coli), and oxacillin (Staphylococcus aureus). We defi ned
20 diff erent exposures according to infection site, microorganism, and resistance status. For every exposure, we
compared outcomes between patients exposed and unexposed by use of time-dependent regression modelling. We
adjusted results for patients’ characteristics and time-dependency of the exposure.
Findings We obtained data for 119 699 patients who were admitted for more than 2 days to 537 intensive-care units in ten
countries between Jan 1, 2005, and Dec 31, 2008. Excess risk of death (hazard ratio) for pneumonia in the fully adjusted
model ranged from 1·7 (95% CI 1·4–1·9) for drug-sensitive S aureus to 3·5 (2·9–4·2) for drug-resistant P aeruginosa. For
bloodstream infections, the excess risk ranged from 2·1 (1·6–2·6) for drug-sensitive S aureus to 4·0 (2·7–5·8) for drugresistant
P aeruginosa. Risk of death associated with antimicrobial resistance (ie, additional risk of death to that of the
infection) was 1·2 (1·1–1·4) for pneumonia and 1·2 (0·9–1·5) for bloodstream infections for a combination of all four
microorganisms, and was highest for S aureus (pneumonia 1·3 [1·0–1·6], bloodstream infections 1·6 [1·1–2·3]).
Antimicrobial resistance did not signifi cantly increase length of stay; the hazard ratio for discharge, dead or alive, for
sensitive microorganisms compared with resistant microorganisms (all four combined) was 1·05 (0·97–1·13) for
pneumonia and 1·02 (0·98–1·17) for bloodstream infections. P aeruginosa had the highest burden of health-care-acquired
infections because of its high prevalence and pathogenicity of both its drug-sensitive and drug-resistant strains.
Lancet Infect Dis 2011; 11: 30–38
Clinical outcomes of health-care-associated infections and antimicrobial resista.pdf
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发表于 2011-11-14 13:55
发表于 2011-11-14 14:05
