M Del Monte, S Kaleci, J Chester, V Zerbato, M Remitti, A Tili, A Dessilani, I Baldisserotto, S Esperti, M D Di Trapani, G Orlando, S Casolari, A Catania, A Bedini, E Franceschini, M Sarti, C Venturelli, I Venturelli, L Rofrano, E Ricchizzi, S Di Bella, C Mussini, M Meschiari
{"title":"万古霉素耐药性对粪肠球菌血流感染的归因死亡率的影响：一项大型多中心回顾性研究的倾向评分分析","authors":"M Del Monte, S Kaleci, J Chester, V Zerbato, M Remitti, A Tili, A Dessilani, I Baldisserotto, S Esperti, M D Di Trapani, G Orlando, S Casolari, A Catania, A Bedini, E Franceschini, M Sarti, C Venturelli, I Venturelli, L Rofrano, E Ricchizzi, S Di Bella, C Mussini, M Meschiari","doi":"10.1093/jac/dkaf242","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Conflicting results exist about mortality risk of infections caused by vancomycin-susceptible Enterococcus faecium (VSEfm) and vancomycin-resistant Enterococcus faecium (VREfm). Our aim was to compare risk factors and clinical outcomes among patients with VSEfm and VREfm bloodstream infections (BSIs).</p><p><strong>Methods: </strong>A retrospective, multicentre, cohort study enrolled consecutive adult patients with VSEfm and VREfm BSI diagnosis between 2018-2022. Primary outcomes were 30-day-attributable and 30-day-overall mortality. Multivariable analysis propensity-weighted adjusted for timing to active therapy, Pitt Bacteremia Score (PBS) and Charlson Comorbidity Index (CCI) were performed to identify variables independently associated with 30-day mortality.</p><p><strong>Results: </strong>Overall, 446 patients were enrolled: 140 (31.4%) VREfm and 306 (68.6%) VSEfm. Comparatively, VREfm patients more frequently received inappropriate antibiotic therapy, had higher sequential organ failure assessment, PBS and BSI relapses. 30-day-attributable and 30-day-overall mortality did not differ significantly between the two groups. Independent risk factors for 30-day attributable mortality were age (HR 1.04, CI95%, 1.00-1.08, P = 0.022), corticosteroid therapy (HR 3.05, CI95%, 1.24-7.47, P = 0.014) and septic shock (HR 9.10, CI95%, 3.80-21.79, P≤0.001), and overall mortality were age (HR 1.04, CI95%, 1.02-1.05, P≤0.001.), chronic liver failure (HR 1.67, CI95%, 1.02-2.75, P = 0.04) and haematological disease (HR 2.25, CI95%, 1.28-3.94, P = 0.005). Vancomycin resistance is not an independent risk factor for mortality when data are adjusted for confounding factors.</p><p><strong>Conclusions: </strong>Adjusted analyses for time to active antibiotic therapy suggest that vancomycin resistance is not an independent risk factor for overall or attributable mortality among patients with Enterococcus faecium BSI. Independent risk factors identified in this study were exclusively comorbidities, severity and corticosteroids use.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":"2466-2473"},"PeriodicalIF":3.6000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404782/pdf/","citationCount":"0","resultStr":"{\"title\":\"Impact of vancomycin resistance on attributable mortality among Enterococcus faecium bloodstream infections: propensity score analysis of a large, multicentre retrospective study.\",\"authors\":\"M Del Monte, S Kaleci, J Chester, V Zerbato, M Remitti, A Tili, A Dessilani, I Baldisserotto, S Esperti, M D Di Trapani, G Orlando, S Casolari, A Catania, A Bedini, E Franceschini, M Sarti, C Venturelli, I Venturelli, L Rofrano, E Ricchizzi, S Di Bella, C Mussini, M Meschiari\",\"doi\":\"10.1093/jac/dkaf242\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Conflicting results exist about mortality risk of infections caused by vancomycin-susceptible Enterococcus faecium (VSEfm) and vancomycin-resistant Enterococcus faecium (VREfm). Our aim was to compare risk factors and clinical outcomes among patients with VSEfm and VREfm bloodstream infections (BSIs).</p><p><strong>Methods: </strong>A retrospective, multicentre, cohort study enrolled consecutive adult patients with VSEfm and VREfm BSI diagnosis between 2018-2022. Primary outcomes were 30-day-attributable and 30-day-overall mortality. Multivariable analysis propensity-weighted adjusted for timing to active therapy, Pitt Bacteremia Score (PBS) and Charlson Comorbidity Index (CCI) were performed to identify variables independently associated with 30-day mortality.</p><p><strong>Results: </strong>Overall, 446 patients were enrolled: 140 (31.4%) VREfm and 306 (68.6%) VSEfm. Comparatively, VREfm patients more frequently received inappropriate antibiotic therapy, had higher sequential organ failure assessment, PBS and BSI relapses. 30-day-attributable and 30-day-overall mortality did not differ significantly between the two groups. Independent risk factors for 30-day attributable mortality were age (HR 1.04, CI95%, 1.00-1.08, P = 0.022), corticosteroid therapy (HR 3.05, CI95%, 1.24-7.47, P = 0.014) and septic shock (HR 9.10, CI95%, 3.80-21.79, P≤0.001), and overall mortality were age (HR 1.04, CI95%, 1.02-1.05, P≤0.001.), chronic liver failure (HR 1.67, CI95%, 1.02-2.75, P = 0.04) and haematological disease (HR 2.25, CI95%, 1.28-3.94, P = 0.005). Vancomycin resistance is not an independent risk factor for mortality when data are adjusted for confounding factors.</p><p><strong>Conclusions: </strong>Adjusted analyses for time to active antibiotic therapy suggest that vancomycin resistance is not an independent risk factor for overall or attributable mortality among patients with Enterococcus faecium BSI. Independent risk factors identified in this study were exclusively comorbidities, severity and corticosteroids use.</p>\",\"PeriodicalId\":14969,\"journal\":{\"name\":\"Journal of Antimicrobial Chemotherapy\",\"volume\":\" \",\"pages\":\"2466-2473\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-09-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12404782/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Antimicrobial Chemotherapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/jac/dkaf242\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Antimicrobial Chemotherapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/jac/dkaf242","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0
摘要
背景：关于万古霉素敏感屎肠球菌（VSEfm）和耐万古霉素屎肠球菌（VREfm）感染引起的死亡风险存在矛盾的结果。我们的目的是比较VSEfm和VREfm血流感染（bsi）患者的危险因素和临床结果。方法：一项回顾性、多中心、队列研究纳入了2018-2022年间诊断为VSEfm和VREfm BSI的连续成年患者。主要结局为30天归因死亡率和30天总死亡率。进行多变量分析倾向加权，调整积极治疗的时间，皮特菌血症评分（PBS）和查尔森合并症指数（CCI），以确定与30天死亡率独立相关的变量。结果：共纳入446例患者：VREfm 140例（31.4%），VSEfm 306例（68.6%）。相比之下，VREfm患者更频繁地接受不适当的抗生素治疗，有更高的序贯器官衰竭评估，PBS和BSI复发。两组间30天归因死亡率和30天总死亡率无显著差异。30天可归因死亡率的独立危险因素为年龄（HR 1.04, CI95%, 1.00-1.08, P = 0.022）、皮质类固醇治疗（HR 3.05, CI95%, 1.24-7.47, P = 0.014）和感染性休克（HR 9.10, CI95%, 3.80-21.79, P≤0.001），总死亡率为年龄（HR 1.04, CI95%, 1.02-1.05, P≤0.001）、慢性肝功能衰竭（HR 1.67, CI95%, 1.02-2.75, P = 0.04）和血液系统疾病（HR 2.25, CI95%, 1.28-3.94, P = 0.005）。在校正混杂因素后，万古霉素耐药性不是死亡率的独立危险因素。结论：对有效抗生素治疗时间的调整分析表明，万古霉素耐药性不是粪肠球菌BSI患者总死亡率或归因死亡率的独立危险因素。本研究确定的独立危险因素完全是合并症、严重程度和皮质类固醇的使用。
Impact of vancomycin resistance on attributable mortality among Enterococcus faecium bloodstream infections: propensity score analysis of a large, multicentre retrospective study.
Background: Conflicting results exist about mortality risk of infections caused by vancomycin-susceptible Enterococcus faecium (VSEfm) and vancomycin-resistant Enterococcus faecium (VREfm). Our aim was to compare risk factors and clinical outcomes among patients with VSEfm and VREfm bloodstream infections (BSIs).
Methods: A retrospective, multicentre, cohort study enrolled consecutive adult patients with VSEfm and VREfm BSI diagnosis between 2018-2022. Primary outcomes were 30-day-attributable and 30-day-overall mortality. Multivariable analysis propensity-weighted adjusted for timing to active therapy, Pitt Bacteremia Score (PBS) and Charlson Comorbidity Index (CCI) were performed to identify variables independently associated with 30-day mortality.
Results: Overall, 446 patients were enrolled: 140 (31.4%) VREfm and 306 (68.6%) VSEfm. Comparatively, VREfm patients more frequently received inappropriate antibiotic therapy, had higher sequential organ failure assessment, PBS and BSI relapses. 30-day-attributable and 30-day-overall mortality did not differ significantly between the two groups. Independent risk factors for 30-day attributable mortality were age (HR 1.04, CI95%, 1.00-1.08, P = 0.022), corticosteroid therapy (HR 3.05, CI95%, 1.24-7.47, P = 0.014) and septic shock (HR 9.10, CI95%, 3.80-21.79, P≤0.001), and overall mortality were age (HR 1.04, CI95%, 1.02-1.05, P≤0.001.), chronic liver failure (HR 1.67, CI95%, 1.02-2.75, P = 0.04) and haematological disease (HR 2.25, CI95%, 1.28-3.94, P = 0.005). Vancomycin resistance is not an independent risk factor for mortality when data are adjusted for confounding factors.
Conclusions: Adjusted analyses for time to active antibiotic therapy suggest that vancomycin resistance is not an independent risk factor for overall or attributable mortality among patients with Enterococcus faecium BSI. Independent risk factors identified in this study were exclusively comorbidities, severity and corticosteroids use.
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The Journal publishes articles that further knowledge and advance the science and application of antimicrobial chemotherapy with antibiotics and antifungal, antiviral and antiprotozoal agents. The Journal publishes primarily in human medicine, and articles in veterinary medicine likely to have an impact on global health.
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