ICU 获得性肠球菌菌血症的流行病学、管理和风险调整死亡率。

Epidemiology, Management, and Risk-Adjusted Mortality of ICU-Acquired Enterococcal Bacteremia.

机构信息

Department of Medical Microbiology Department of Intensive Care Medicine Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht.

Department of Medical Microbiology Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht.

出版信息

Clin Infect Dis. 2015 Nov 1;61(9):1413-20. doi: 10.1093/cid/civ560. Epub 2015 Jul 15.

DOI:10.1093/cid/civ560

PMID:26179013

Abstract

BACKGROUND

Enterococcal bacteremia has been associated with high case fatality, but it remains unknown to what extent death is caused by these infections. We therefore quantified attributable mortality of intensive care unit (ICU)-acquired bacteremia caused by enterococci.

METHODS

From 2011 to 2013 we studied consecutive patients who stayed >48 hours in 2 tertiary ICUs in the Netherlands, using competing risk survival regression and marginal structural modeling to estimate ICU mortality caused by enterococcal bacteremia.

RESULTS

Among 3080 admissions, 266 events of ICU-acquired bacteremia occurred in 218 (7.1%) patients, of which 76 were caused by enterococci (incidence rate, 3.0 per 1000 patient-days at risk; 95% confidence interval [CI], 2.3-3.7). A catheter-related bloodstream infection (CRBSI) was suspected in 44 (58%) of these, prompting removal of 68% of indwelling catheters and initiation of antibiotic treatment for a median duration of 3 (interquartile range 1-7) days. Enterococcal bacteremia was independently associated with an increased case fatality rate (adjusted subdistribution hazard ratio [SHR], 2.68; 95% CI, 1.44-4.98). However, for patients with CRBSI, case fatality was similar for infections caused by enterococci and coagulase-negative staphylococci (CoNS; adjusted SHR, 0.91; 95% CI, .50-1.67). Population-attributable fraction of mortality was 4.9% (95% CI, 2.9%-6.9%) by day 90, reflecting a population-attributable risk of 0.8% (95% CI, .4%-1.1%).

CONCLUSIONS

ICU-acquired enterococcal bacteremia is associated with increased case fatality; however, the mortality attributable to these infections is low from a population perspective. The virulence of enterococci and CoNS in a setting of CRBSI seems comparable.

摘要

背景

肠球菌菌血症与高病死率相关，但目前尚不清楚这些感染在多大程度上导致了死亡。因此，我们量化了重症监护病房（ICU）获得性肠球菌菌血症导致的可归因死亡率。

方法

我们研究了 2011 年至 2013 年期间在荷兰 2 家三级 ICU 住院时间超过 48 小时的连续患者，使用竞争风险生存回归和边缘结构模型来估计 ICU 获得性肠球菌菌血症导致的死亡率。

结果

在 3080 例住院患者中，218 例（7.1%）患者发生了 266 例 ICU 获得性菌血症，其中 76 例由肠球菌引起（发病率为每 1000 个患者日风险 3.0 例；95%置信区间 [CI]，2.3-3.7）。其中 44 例（58%）疑似导管相关血流感染（CRBSI），导致留置导管 68%被移除，并开始使用抗生素治疗，中位持续时间为 3 天（四分位距 1-7 天）。肠球菌菌血症与病死率增加独立相关（调整后的亚分布危险比 [SHR]，2.68；95%CI，1.44-4.98）。然而，对于患有 CRBSI 的患者，肠球菌和凝固酶阴性葡萄球菌（CoNS）引起的感染的病死率相似（调整后的 SHR，0.91；95%CI，0.50-1.67）。第 90 天时，死亡率的人群归因分数为 4.9%（95%CI，2.9%-6.9%），反映了人群归因风险为 0.8%（95%CI，0.4%-1.1%）。