传染病专家建议后治疗失败的相关因素

IF 5 Q3 Medicine

Medecine et maladies infectieuses Pub Date : 2020-11-01 DOI:10.1016/j.medmal.2019.11.003

A. Martin , Y. Ruch , N. Douiri , P. Boyer , X. Argemi , Y. Hansmann , N. Lefebvre

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引用次数: 0

摘要

目的:传染病专科医生(IDS)建议后治疗失败的相关风险因素尚不清楚。我们的目标是确定这些风险因素。方法纳入2013年1月至2015年4月在我院三级保健中心就诊并咨询过传染病专家的患者。治疗失败由一个综合标准定义:脓毒症症状超过3天，ICU入院或死亡。治疗成功的定义是患者的持续临床改善。结果共提出了240条IDS建议。64例(26.7%)患者的诊断发生改变，50例患者在接受IDS建议后治疗失败。在多变量分析中，遵从IDS建议与较高的成功率相关(OR = 0.09, 95%CI[0.01-0.67])。多因素分析中与治疗失败相关的变量为入院时Charlson合并症评分(OR = 1.24, 95%CI[1.03-1.50])、感染或多药耐药菌定植史(OR = 8.27, 95%CI[1.37-49.80])以及IDS建议后3天患者病情恶化(OR = 12.50, 95%CI[3.16-49.46])。结论重新评估IDS建议对特定患者有重要意义，可进一步适应和改进IDS建议。

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Factors associated with treatment failure after advice from infectious disease specialists

Objective

Risk factors associated with treatment failure after the infectious disease specialist's (IDS) advice remain unknown. We aimed to identify these risk factors.

Methods

We included patients hospitalized in our tertiary care center who consulted an infectious disease specialist between January 2013 and April 2015. Treatment failure was defined by a composite criterion: signs of sepsis beyond Day 3, ICU admission, or death. Treatment success was defined by the patient's sustained clinical improvement.

Results

A total of 240 IDS recommendations were made. Diagnosis was changed for 64 patients (26.7%) and 50 patients experienced treatment failure after the IDS advice. In multivariate analysis, compliance with the IDS advice was associated with a higher rate of success (OR = 0.09, 95%CI [0.01–0.67]). Variables associated with treatment failure in the multivariate analysis were Charlson comorbidity score at admission (OR = 1.24, 95%CI [1.03–1.50]), a history of infection or colonization with multidrug-resistant bacteria (OR = 8.27, 95%CI [1.37–49.80]), and deterioration of the patient's status three days after the IDS advice (OR = 12.50, 95%CI [3.16–49.46]).

Conclusion

Reassessing IDS recommendations could be interesting for specific patients to further adapt and improve them.

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来源期刊

Medecine et maladies infectieuses 医学-传染病学

CiteScore

1.10

自引率

0.00%

发文量

审稿时长

10.7 weeks

期刊介绍： L''organe d''expression de la Société de Pathologie Infectieuse de Langue Française (SPILF). Médecine et Maladies Infectieuses is the official publication of the Société de Pathologie Infectieuse de Langue Française (SPILF). Médecine et Maladies Infectieuses is indexed in the major databases: Medline, Web of Science/Clarivate and Scopus. The journal publishes scientific /research articles, general reviews, short communications and letters, in both English and French. The journal welcomes submissions on the various aspects of infectious pathologies and pathogenic agents. Médecine et Maladies Infectieuses focuses on clinical therapeutics, nosocomial infections, biology, prevention, as well as epidemiology and therapeutics.