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題名 | Risk Factors and Outcomes of Carbapenem-nonsusceptible Escherichia coli Bacteremia: A Matched Case-control Study= |
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作者 | Chang, Hong-jyun; Hsu, Po-chang; Yang, Chien-chang; Kuo, An-jing; Chia, Ju-hsin; Wu, Tsu-lan; Lee, Ming-hsun; |
期刊 | Journal of Microbiology, Immunology and Infection |
出版日期 | 20110400 |
卷期 | 44:2 2011.04[民100.04] |
頁次 | 頁125-130 |
分類號 | 415.27 |
語文 | eng |
關鍵詞 | Bacteremia; Carbapenem nonsusceptible; Escherichia coli; |
英文摘要 | Background: Infections due to carbapenem-resistant Enterobacteriaceae have been the emerging problem worldwide. This primary object of this study was to understand the risk factors and clinical outcomes of carbapenem-nonsusceptible Escherichia coli (CNSEc) bacteremia. Methods: We conducted a matched caseecontrol study in a 3,715-bed tertiary care medical center in northern Taiwan. The controls were selected among patients with carbapenemsusceptible E coli and were matched with CNSEc for bacteremia. Results: Fifty-one patients were included in this study (17 cases and 34 controls). Bivariate analysis showed that prior exposure to carbapenems (p < 0.001), stay in intensive care units (pZ0.016), placement of central venous catheters (pZ0.001), chronic liver diseases (p < 0.001), uremia with regular dialysis (pZ0.004), and mechanical ventilation (pZ0.004) were associated with CNSEc bacteremia. Multivariate analysis revealed that prior exposure to carbapenems [odds ratio (OR), 29.17; 95% confidence interval (CI), 1.76e484.70; pZ0.019], uremia with regular dialysis (OR, 98.58; 95% CI, 4.02e999; pZ0.005) and chronic liver diseases (OR, 27.86; 95% CI, 2.31e335.83; pZ0.009) were independent risk factors for CNSEc bacteremia. Compared with carbapenem-susceptible E coli group, CNSEc group had a longer hospital stay (68.4 days vs. 35.8 days; pZ0.04) and a higher disease severity, as indicated by a Pittsburgh bacteremia score greater than or equal to 4 (5.6% vs. 2.5%; pZ0.015). Patients with CNSEc bacteremia had a higher overall in-hospital mortality rate (94.12% vs. 50.00%; pZ0.002), but there was no difference in the 28-day mortality between these two groups. Conclusions: CNSEc bacteremia would lead to a poor outcome among patients with prior exposure to carbapenems, chronic liver disease, and uremia with regular dialysis. |
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