鲍曼不动杆菌血流感染的死亡风险因素及死亡率预测模型的开发。

IF 3.7 3区 医学 Q2 INFECTIOUS DISEASES Journal of global antimicrobial resistance Pub Date : 2024-07-17 DOI:10.1016/j.jgar.2024.06.010
Silvia Corcione , Bianca Maria Longo , Silvia Scabini , Emanuele Pivetta , Antonio Curtoni , Nour Shbaklo , Cristina Costa , Francesco Giuseppe De Rosa
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引用次数: 0

摘要

背景:鲍曼不动杆菌院内感染对公共卫生构成严重危害,因为死亡率高且多重耐药性迅速蔓延:方法:2019 年至 2023 年期间,在一个单一中心对所有连续住院的鲍曼不动杆菌菌血症成人患者进行回顾性登记:主要结果是评估耐碳青霉烯类和对碳青霉烯类敏感的鲍曼不动杆菌引起的血流感染(BSI)14 天和 30 天死亡率的预测因素。次要终点是确定耐碳青霉烯类鲍曼不动杆菌(CRAB)所致BSI的风险因素,并建立CRAB相关BSI的死亡率预测模型:共记录了126例由鲍曼不动杆菌引起的BSI,其中89.7%是由耐碳青霉烯鲍曼不动杆菌引起的。近期烧伤、年龄较大、既往有CRAB定植和抗生素接触被认为是感染CRAB BSI的风险因素。总体而言,26.1%的患者在14天内死亡,30.9%的患者在30天内死亡。在多变量分析中,序贯器官衰竭评估(SOFA)评分与 14 天和 30 天死亡率相关,而烧伤与 30 天存活率相关。并发冠状病毒病(COVID)与死亡率有关,但未达到统计学水平。没有观察到接受适当治疗会产生重大影响。基于这些发现,我们建立了一个多变量模型来预测CRAB BSI患者的死亡率,并在内部进行了验证:结论:鲍曼不动杆菌 BSI 的特点是治疗效果差、治疗方案有限。本研究旨在帮助医生及时发现死亡风险较高的患者,从而做出更明智的临床决策。
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Risk factors for mortality in Acinetobacter baumannii bloodstream infections and development of a predictive mortality model

Objectives

Acinetobacter baumannii (A. baumannii) nosocomial infections represent a serious hazard to public health, given high mortality rates and rapid spread of multidrug-resistance. The primary outcome of this study was to evaluate predictors of 14- and 30-d mortality in bloodstream infections (BSIs) due to both carbapenem-resistant and carbapenem-sensitive Acinetobacter. Secondary end points were to identify risk factors for BSIs due to carbapenem-resistant A. baumannii (CRAB) and to develop a predictive model for mortality in CRAB-related BSIs.

Methods

Between 2019 and 2023, all consecutive hospitalized adult patients with bacteraemia due to A. baumannii were retrospectively enrolled at a single-centre.

Results

One hundred twenty-six episodes of BSI caused by A. baumannii were recorded, 89.7% of which were due to CRAB. Recent burn injuries, older age, previous CRAB colonization, and antibiotics exposure were identified as risk factors for acquiring CRAB BSI. Overall, 14-d mortality was observed in 26.1% of the patients and 30-d mortality in 30.9% of the patients. On multivariate analysis, the Sequential Organ Failure Assessment (SOFA) score was associated with both 14- and 30-d mortality, whereas burn injuries correlated with 30-d survival. Concurrent coronavirus disease (COVID) was associated with mortality, although not reaching statistical figures. No major impact of receiving appropriate treatment was observed. Based on these findings, a multivariable model to predict mortality among patients with CRAB BSI was built and internally validated.

Conclusions

A. baumannii BSIs are characterized by poor outcomes and limited therapeutic options. This study aimed to assist physicians in prompt identification of patients who are at greater risk of death, contributing to more informed clinical decision making.

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来源期刊
Journal of global antimicrobial resistance
Journal of global antimicrobial resistance INFECTIOUS DISEASES-PHARMACOLOGY & PHARMACY
CiteScore
8.70
自引率
2.20%
发文量
285
审稿时长
34 weeks
期刊介绍: The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes. JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR). Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.
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