2009-2022 年退伍军人卫生管理局系统铜绿假单胞菌血流感染发病率和耐药性的 14 年流行病学研究。

IF 3.7 Q2 INFECTIOUS DISEASES JAC-Antimicrobial Resistance Pub Date : 2024-03-05 eCollection Date: 2024-04-01 DOI:10.1093/jacamr/dlae031
Leila S Hojat, Brigid M Wilson, Michael J Satlin, Federico Perez, Maria F Mojica, Mendel E Singer, Robert A Bonomo, Lauren H Epstein
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引用次数: 0

摘要

背景:耐多药铜绿假单胞菌(PA)对住院患者构成严重威胁。确定 PA 感染的发病率和耐药程度可为经验性治疗和预防措施提供依据:我们试图描述退伍军人健康管理局(VHA)系统中观察到的 PA 血流感染(BSI)的发病率和耐药性特征趋势,并确定导致该人群中观察到的死亡率较高的因素:我们描述了 2009 年至 2022 年间首次出现 PA-BSI 的退伍军人健康管理局人群中特殊患者的人口统计学和临床特征,并根据年份和地理位置总结了与死亡率和耐药表型相关的趋势。此外,我们还使用逻辑回归分析来确定该人群 30 天死亡率的预测因素:我们在研究期间发现了 8039 例 PA-BSI,其中 32.7% 在医院发病。在研究期间,每年的 PA-BSI 病例减少了 35.8%,所有抗菌药物类别的耐药性均有所下降,而根据药敏试验结果接受早期积极治疗的患者比例有所增加。30 天平均死亡率为 23.3%。较高的夏尔森综合指数、较高的mAPACHE评分、VHA设施复杂程度1b和住院病例与较高的死亡率有关,而早期积极治疗与较低的死亡率有关:结论:在研究期间,整个 VHA 系统的 PA-BSI 耐药性有所下降。有必要进一步调查抗菌药物管理措施可能导致该队列中耐药性下降的原因,并确定措施以改善与 VHA 人口中 PA-BSI 相关的高死亡率。
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14-Year Epidemiologic study of Pseudomonas aeruginosa bloodstream infection incidence and resistance in the Veterans Health Administration system, 2009-2022.

Background: Multidrug resistant Pseudomonas aeruginosa (PA) represents a serious threat to hospitalized patients. Characterizing the incidence of PA infection and degree of resistance can inform empiric treatment and preventative measures.

Objectives: We sought to describe trends in incidence and resistance characteristics of PA bloodstream infections (BSI) observed within the Veterans Health Administration (VHA) system and identify factors contributing to higher observed mortality within this population.

Methods: We characterized demographic and clinical features of unique patients among the VHA population presenting with their first episode of PA-BSI between 2009 and 2022 and summarized trends related to mortality and resistance phenotype based on year and geographical location. We additionally used logistic regression analysis to identify predictors of 30-day mortality among this cohort.

Results: We identified 8039 PA-BSIs during the study period, 32.7% of which were hospital onset. Annual PA-BSI cases decreased by 35.8%, and resistance among all antimicrobial classes decreased during the study period, while the proportion of patients receiving early active treatment based on susceptibility testing results increased. Average 30-day mortality rate was 23.3%. Higher Charlson Comorbidity Index, higher mAPACHE score, VHA facility complexity 1b and hospital-onset cases were associated with higher mortality, and early active treatment was associated with lower mortality.

Conclusions: PA-BSI resistance decreased across the VHA system during the study period. Further investigation of antimicrobial stewardship measures possibly contributing to the observed decreased resistance in this cohort and identification of measures to improve on the high mortality associated with PA-BSI in the VHA population is warranted.

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