耐万古霉素肠球菌、耐甲氧西林金黄色葡萄球菌或艰难梭菌的定植与败血症死亡率之间是否存在关联？

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice Pub Date : 2024-10-26 DOI:10.1016/j.infpip.2024.100413

Matthew JG. Sigakis , Joseph Posluszny , Michael D. Maile , Elizabeth S. Jewell , Milo Engoren

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引用次数: 0

摘要

方法对脓毒症患者进行回顾性研究，采用逻辑回归和线性回归确定定植与不良预后的独立关联。结果VRE定植患者的死亡率较高[1937例患者中的501例（26%）v. 5624例非VRE定植患者中的1052例（19%），差异为7%（95%置信区间（5,9%），p<0.001）]，MRSA定植患者的死亡率较高[708例患者中的168例（24%）v. 6804例非MRSA定植患者中的1342例（20%），差异为4%（1,7%），p = 0.014]。CDiff 定植与死亡率增加无关[757 例中的 153 例（21%）v 7432 例中的 762 例（18%），差异为 3% (0,6%)，P=0.052]。多变量逻辑回归后，VRE 定植仍与住院死亡率增加相关[几率比 = 1.273，95% 置信区间 (1.099, 1.475)，p = 0.001]。VRE 定植还与随后接受机械通气[几率比 = 1.179，95% 置信区间 (1.043，1.334)，p = 0.009]和接受肾脏替代治疗 (RRT) [OR = 1.36 (1.11，1.66)，p = 0.003]有关。

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Is there an association between colonisation of vancomycin resistant Enterococci, methicillin resistant Staphylococcus Aureus, or Clostridiodes Difficile and mortality in sepsis?

Background

To determine if colonisation with drug resistant organisms is associated with worse outcomes in patients who subsequently develop sepsis.

Methods

Retrospective study of patients with sepsis employing logistic regression and linear regression to determine the independent association of colonisation with adverse outcomes.

Results

Mortality was higher in patients colonized with VRE [501 of 1937 (26%) v. 1052 of 5624 (19%) non-VRE colonised patients, difference 7% (95% confidence interval (5,9%), p<0.001] and MRSA [168 of 708 (24%) v 1342 of 6804 (20%) non-MRSA colonised patients, difference 4% (1,7%), p = 0.014]. CDiff colonisation was not associated with increased mortality [153 of 757 (21%) v 762 of 7432 (18%), difference 3% (0,6%), p=0.052]. After multivariable logistic regression, VRE colonisation remained associated with increased hospital mortality [odds ratio = 1.273, 95% confidence interval (1.099, 1.475), p = 0.001]. VRE colonisation was also associated with subsequent receipt of mechanical ventilation [odds ratio = 1.179, 95% confidence interval (1.043, 1.334), p = 0.009] and with receipt of renal replacement therapy (RRT) [OR = 1.36 (1.11, 1.66), p = 0.003].