多重耐药细菌所引起的死亡率的权威数据？

细菌耐药

Respiration. 2011 Oct 12. [Epub ahead of print]
Pseudomonas aeruginosa and Mortality after Hospital Admission for Chronic Obstructive Pulmonary Disease.
Almagro P, Salvadó M, Garcia-Vidal C, Rodríguez-Carballeira M, Cuchi E, Torres J, Ll Heredia J.
SourceServices of Internal Medicine, Hospital Universitari Mutua de Terrassa, University of Barcelona, Barcelona, Spain.

Abstract
Background:Pseudomonas aeruginosa (PA) is isolated in advanced stages of chronic obstructive pulmonary disease (COPD). Objectives: The aim of our study was to determine whether PA isolation during hospitalization for COPD exacerbation was associated with a poorer prognosis after discharge. Methods: We prospectively studied all patients with COPD exacerbation admitted between June 2003 and September 2004. A sputum culture was obtained at admission. Comorbidity, functional dependence, hospitalizations during the previous year, dyspnea, quality of life and other variables previously associated with mortality in COPD were studied. Spirometry and a 6-min walking test were performed 1 month after discharge. Mortality was evaluated 3 years after discharge. Results: A total of 181 patients were included in the study. Of these, 29 (16%) had PA in the sputum. The mean age was 72 years, and mean basal postbronchodilator forced expiratory volume in 1 s was 45.2% predicted (SD 14.4). The mean point value on the BODE index was 5.1 (SD 2.5). At 3 years, 17 of 29 patients (58.6%) in the PA group had died, compared to 53 of the 152 non-PA patients [34.9%; p < 0.004; hazard ratio (HR) 2.23, 95% confidence interval (CI) 1.29-3.86]. In the multivariate analysis, PA remained statistically related to posthospital mortality (p = 0.02; HR 2.2, 95% CI 1.2-4.2) after adjustment for age (p < 0.02; HR 1.04, 95% CI 1.007-1.07), BODE index (p < 0.02; HR 1.15, 95% CI 1.02-1.3) and comorbidity (p < 0.02; HR 1.24, 95% CI 1.03-1.5). Conclusions: PA isolation in sputum in patients hospitalized for acute exacerbation of COPD is a prognostic marker of 3-year mortality. Poor prognosis is independent of other significant predictors of mortality such as BODE index, age and comorbidity, as measured by the Charlson index.

细菌耐药

Microb Drug Resist. 2011 Jun;17(2):305-12. Epub 2011 Mar 7.
Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia: clinical impact of antimicrobial resistance on outcome.
Joo EJ, Kang CI, Ha YE, Kang SJ, Park SY, Chung DR, Peck KR, Lee NY, Song JH.
SourceDivision of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Abstract
Despite the high prevalence of antimicrobial resistance among Pseudomonas aeruginosa bacteremia, the clinical consequence of resistance remains unclear. The purpose of this study was to identify predictors of mortality and evaluate the clinical impact of antimicrobial resistance on outcome in P. aeruginosa bacteremia. A retrospective cohort study including patients with P. aeruginosa bacteremia was performed. The risk factors for antimicrobial resistances were evaluated, and the impact of the respective resistances on mortality was assessed. Of 202 P. aeruginosa bacteremia cases, the resistance rates to ceftazidime, piperacillin, imipenem, fluoroquinolone, and aminoglycoside were 36.6%, 22.3%, 22.8%, 23.8%, and 17.8%, respectively. A prior use of fluoroquinolones and an indwelling urinary catheter were common risk factors for all types of antimicrobial resistance. The overall 30-day mortality rate was 25.2% (51/202), and the risk factors for mortality were corticosteroid use, nosocomial acquisition, polymicrobial infection, an increasing Charlson's weighted co-morbidity index, and intensive care unit care (p&#8201;<&#8201;0.05). As compared with the susceptible group, ceftazidime-, piperacillin-, or imipenem-resistant groups had a higher mortality (p&#8201;<&#8201;0.05). A multivariate analysis showed that resistance to ceftazidime or imipenem remained a significant factor associated with mortality (odds ratio, 2.96; 95% confidential interval, 1.20-7.31; and odds ratio, 2.74; 95% confidential interval, 1.02-7.31, respectively). Antimicrobial resistance, especially to ceftazidime or imipenem, adversely affected outcome in patients with P. aeruginosa bacteremia.

细菌耐药

Epidemiol Infect. 2011 Jan 13:1-10. [Epub ahead of print]
Multidrug-resistant Pseudomonas aeruginosa bloodstream infections: risk factors and mortality.
Tumbarello M, Repetto E, Trecarichi EM, Bernardini C, DE Pascale G, Parisini A, Rossi M, Molinari MP, Spanu T, Viscoli C, Cauda R, Bassetti M.
SourceInstitute of Infectious Diseases, Catholic University of the Sacred Heart, Roma, Italy.

Abstract
SUMMARYWe retrospectively studied patients diagnosed with P. aeruginosa bloodstream infections (BSIs) in two Italian university hospitals. Risk factors for the isolation of multidrug-resistant (MDR) or non-MDR P. aeruginosa in blood cultures were identified by a case-case-control study, and a cohort study evaluated the clinical outcomes of such infections. We identified 106 patients with P. aeruginosa BSI over the 2-year study period; 40 cases with MDR P. aeruginosa and 66 cases with non-MDR P. aeruginosa were compared to 212 controls. Independent risk factors for the isolation of MDR P. aeruginosa were: presence of central venous catheter (CVC), previous antibiotic therapy, and corticosteroid therapy. Independent risk factors for non-MDR P. aeruginosa were: previous BSI, neutrophil count <500/mm3, urinary catheterization, and presence of CVC. The 21-day mortality rate of all patients was 33&Acirc;·9%. The variables independently associated with 21-day mortality were presentation with septic shock, infection due to MDR P. aeruginosa, and inadequate initial antimicrobial therapy.

细菌耐药

J Crit Care. 2009 Dec;24(4):625.e9-14. Epub 2009 Jul 9.
Imipenem-resistant Pseudomonas aeruginosa infection at a medical-surgical intensive care unit: risk factors and mortality.
Furtado GH, Bergamasco MD, Menezes FG, Marques D, Silva A, Perdiz LB, Wey SB, Medeiros EA.
SourceHospital Epidemiology Committee, Division of Infectious Diseases, Federal University of S&atilde;o Paulo, S&atilde;o Paulo, Brazil. ghfurtado@uol.com.br

Abstract
OBJECTIVES: The aim of this study was to evaluate the risk factors and attributable mortality associated with imipenem-resistant Pseudomonas aeruginosa (IRPA) infections in a medical-surgical intensive care unit (ICU).

METHODS: A retrospective case-control study was carried out at a 16-bed medical-surgical ICU in a 780-bed, university-affiliated hospital. All patients admitted from January 1, 2003, to December 31, 2004, who had nosocomial infection caused by IRPA, were included in the study.

RESULTS: Imipenem-resistant P. aeruginosa was recovered from 63 patients during the study period. One hundred eighty-two controls were matched with cases by period of admission, age, and time at risk. Urinary tract (34.9%) and respiratory tract (22.2%) were the main sources of IRPA isolation. In multivariate analysis, a previous stay in the ICU (odds ratio, 3.54; 95% confidence interval [CI], 1.29-9.73; P = .03) was the only independent risk factor for IRPA infection. The in-hospital mortality rate among case patients was 49% (31 of 63) compared with 33% (61 of 182) for control patients (odds ratio, 1.92; 95% CI, 1.07-3.44; P = .02). Thus, we had an attributable mortality of 16% (95% CI, 9.74%-22.3%; P = .03).

CONCLUSIONS: Our study suggests that IRPA infections are strongly related to previous ICU stay, and that IRPA infections significantly increase mortality in those critical patients.

细菌耐药

Crit Care. 2006;10(4):R114.
Reappraisal of Pseudomonas aeruginosa hospital-acquired pneumonia mortality in the era of metallo-beta-lactamase-mediated multidrug resistance: a prospective observational study.
Zavascki AP, Barth AL, Fernandes JF, Moro AL, Gon&ccedil;alves AL, Goldani LZ.
SourceInfectious Diseases Service, Hospital S&atilde;o Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre - RS, Brazil. apzavascki@terra.com.br

Abstract
INTRODUCTION: Hospital-acquired pneumonia (HAP) due to Pseudomonas aeruginosa is associated with high mortality rates. The metallo-beta-lactamases (MBLs) are emerging enzymes that hydrolyze virtually all beta-lactams. We aimed to assess P. aeruginosa HAP mortality in a setting of high-rate MBL production

METHODS: A prospective cohort study was performed at two tertiary-care teaching hospitals. A logistic regression model was constructed to identify risk factors for 30-day mortality.

RESULTS: One-hundred and fifty patients with P. aeruginosa HAP were evaluated. The 30-day mortality was 37.3% (56 of 150): 57.1% (24 of 42) and 29.6% (32 of 108) for patients with HAP by MBL-producing P. aeruginosa and by non-MBL-producing P. aeruginosa, respectively (relative risk, 1.93; 95% confidence interval (CI), 1.30-2.85). The logistic regression model identified a higher Charlson comorbidity score (odds ratio, 1.21; 95% CI, 1.04-1.41), presentation with severe sepsis or septic shock (odds ratio, 3.17; 95% CI, 1.30-7.72), ventilator-associated pneumonia (odds ratio, 2.92; 95% CI, 1.18-7.21), and appropriate therapy (odds ratio, 0.24; 95% CI, 0.10-0.61) as independent factors for 30-day mortality. MBL production was not statistically significant in the final model.

CONCLUSION: MBL-producing P. aeruginosa HAP resulted in higher mortality rates, particularly in patients with ventilator-associated pneumonia, most probably related to the less frequent institution of appropriate antimicrobial therapy. Therapeutic approaches should be reviewed at institutions with a high prevalence of MBL.

细菌耐药

J Antimicrob Chemother. 2006 Aug;58(2):387-92. Epub 2006 Jun 3.
The influence of metallo-beta-lactamase production on mortality in nosocomial Pseudomonas aeruginosa infections.
Zavascki AP, Barth AL, Gon&ccedil;alves AL, Moro AL, Fernandes JF, Martins AF, Ramos F, Goldani LZ.
SourceInfectious Diseases Service, Hospital S&atilde;o Lucas da Pontifícia Universidade Católica do Rio Grande do Sul Porto Alegre, Brazil. apzavascki@terra.com.br

Abstract
OBJECTIVES: To assess the effect of metallo-beta-lactamase (MBL) production on Pseudomonas aeruginosa nosocomial infection mortality and to identify the determinants of such effect.

METHODS: A cohort study of patients with P. aeruginosa nosocomial infections was conducted at two teaching hospitals. MBL was detected by ceftazidime/2-mercaptopropionic disc approximation test and selected isolates were submitted to PCR using bla(SPM-1) primer. Molecular typing was performed by DNA macrorestriction. To evaluate the influence of MBL on mortality a Cox proportional hazards model was performed using a hierarchized framework of the variables.

RESULTS: A total of 298 patients with P. aeruginosa infections were included. Infections by MBL-carrying Pseudomonas aeruginosa (MBL-PA) resulted in higher in-hospital mortality than those by non-MBL-PA (51.2% versus 32.1%, respectively; relative risk 1.60, 95% CI 1.20-2.12) and higher mortality rates [17.3 per 1000 versus 11.8 per 1000 patient-days, respectively; hazard ratio (HR) 1.55, 95% CI 1.06-2.27]. In the final multivariate model, severe sepsis or septic shock [adjusted HR (AHR) 3.62, 95% CI 2.41-5.43], age (AHR 1.02, 95% CI 1.01-1.03) and use of appropriate therapy<or=72 h (AHR 0.49, 95% CI 0.32-0.76) were significantly associated with mortality. Fourteen MBL-PA tested carried the blaSPM-1 gene. Clonal dissemination was documented in both hospitals.

CONCLUSIONS: MBL-PA infections resulted in higher mortality rates most likely related to the severity of these infections and less frequent early institution of appropriate antimicrobial therapy. Empirical treatments should be reviewed at institutions with high prevalence of MBL.

细菌耐药

Microb Drug Resist. 2005 Spring;11(1):68-74.
Risk factors for antimicrobial resistance and influence of resistance on mortality in patients with bloodstream infection caused by Pseudomonas aeruginosa.
Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, Oh MD, Choe KW.
SourceDepartment of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Abstract
This study was conducted to evaluate risk factors for antimicrobial resistance and influence of resistance on mortality in Pseudomonas aeruginosa bacteremia. Data on 190 patients with P. aeruginosa bacteremia were analyzed retrospectively. Antimicrobial resistance to antipseudomonal antibiotics was evaluated. The main outcome measure was 30-day mortality. In P. aeruginosa bacteremia, resistance rates to piperacillin (PIP), ceftazidime (CAZ), ciprofloxacin (CIP), and imipenem (IPM) were 29 (56/190), 19 (36/190), 17 (32/190) and 15% (28/190), respectively. Prior uses of fluoroquinolones or carbapenems were independent risk factors for resistance to CIP and IPM, and prior use of extended-spectrum cephalosporins was a risk factor for PIP-R. An indwelling urinary catheter was a risk factor for PIP-R, CAZ-R, and CIP-R. An invasive procedure was a risk factor for CIP-R and IPM-R. The 30-day mortality rate was 44% (33/75) in patients infected by strains resistant to any of the antipseudomonal antibiotics, but 33.9% (39/115) in those by strains susceptible to all antipseudomonal antibiotics (p = 0.161). Among patients with bloodstream infection due to antimicrobial-resistant P. aeruginosa, those infected by IPM-R strains had the highest mortality (IPM-R, 53.6% vs. CAZ-R, 47.2% vs. CIP-R 46.9%, PIP-R, 39.3%). In this study regarding P. aeruginosa bacteremia, prior uses of fluoroquinolones, carbapenems, or extended-spectrum cephalosporins, a prior invasive procedure, and an indwelling urinary catheter were found to be associated with antimicrobial resistance. The patients with bloodstream infection caused by antimicrobial-resistant P. aeruginosa, especially to imipenem, had a tendency toward higher mortality than those infected by susceptible strains.

milin

多重耐药不是死亡的独立危险因素，该评价是客观的。 但是，病人和家属可不会这么理解。