现在的位置: 首页时讯速递, 进展交流>正文
[Lancet Infect Dis发表论文]:碳青霉烯耐药对中低收入国家肠杆菌科细菌血行性感染临床预后的影响
2019年07月10日 时讯速递, 进展交流 暂无评论

ARTICLES| VOLUME 19, ISSUE 6, P601-610, JUNE 01, 2019

Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study

Andrew J Stewardson, Kalisvar Marimuthu, Sharmila Sengupta, et al

Lancet Infect Dis 2019; 19: 601-610

Summary

Background 背景

Low-income and middle-income countries (LMICs) are under-represented in reports on the burden of antimicrobial resistance. We aimed to quantify the clinical effect of carbapenem resistance on mortality and length of hospital stay among inpatients in LMICs with a bloodstream infection due to Enterobacteriaceae.

有关抗生素耐药负担的报告中很少涉及中低收入国家(LMICs)的情况。本研究旨在定量反映碳青霉烯耐药对LMICs内肠杆菌科细菌血行性感染病死率及住院日的影响。

Methods 方法

The PANORAMA study was a multinational prospective cohort study at tertiary hospitals in Bangladesh, Colombia, Egypt, Ghana, India, Lebanon, Nepal, Nigeria, Pakistan, and Vietnam, recruiting consecutively diagnosed patients with carbapenem-susceptible Enterobacteriaceae (CSE) and carbapenem-resistant Entero-bacteriaceae (CRE) bloodstream infections. We excluded patients who had previously been enrolled in the study and those not treated with curative intent at the time of bloodstream infection onset. There were no age restrictions. Central laboratories in India and the UK did confirmatory testing and molecular characterisation, including strain typing. We applied proportional subdistribution hazard models with inverse probability weighting to estimate the effect of carbapenem resistance on probability of discharge alive and in-hospital death, and multistate modelling for excess length of stay in hospital. All patients were included in the analysis.

PANORAMA研究是在缅甸、哥伦比亚、埃及、加纳、印度、黎巴嫩、尼泊尔、尼日利亚、巴基斯坦和越南进行的一项多国前瞻性队列研究,纳入连续诊断的碳青霉烯敏感(CSE)以及碳青霉烯耐药(CRE)肠杆菌科血行性感染病例。我们排除了既往入选本研究的患者,以及在发生血行性感染时不再接受积极治疗的患者。入选患者不限制年龄。印度和英国的中心实验室进行确诊试验及分子特征检测,包括菌株分型。我们采用根据反向概率权重的比例分配风险模型预测碳青霉烯耐药对存活出院及住院期间死亡的概率的影响,并采用多状态模型评估对住院日的影响。所有患者均纳入分析。

Findings 结果

Between Aug 1, 2014, and June 30, 2015, we recruited 297 patients from 16 sites in ten countries: 174 with CSE bloodstream infection and 123 with CRE bloodstream infection. Median age was 46 years (IQR 15–61). Crude mortality was 20% (35 of 174 patients) for patients with CSE bloodstream infection and 35% (43 of 123 patients) for patients with CRE bloodstream infection. Carbapenem resistance was associated with an increased length of hospital stay (3·7 days, 95% CI 0·3–6·9), increased probability of in-hospital mortality (adjusted subdistribution hazard ratio 1·75, 95% CI 1·04–2·94), and decreased probability of discharge alive (0·61, 0·45–0·83). Multilocus sequence typing showed various clades, with marginal overlap between strains in the CRE and CSE clades.

从2014年8月1日至2015年6月30日,我们共纳入10个国家16个中心的297名患者:174名患者为CSE血行性感染,123名患者为CRE血行性感染。中位年龄为46 岁 (IQR 15–61)。粗病死率为CSE血行性感染病例 20% (35/174),CRE血行性感染病例 35% (43/123)。碳青霉烯耐药伴随住院日延长 (3·7 天, 95% CI 0·3–6·9),住院病死率增加 (校正后分布风险比 1·75, 95% CI 1·04–2·94),以及存活出院率降低 (0·61, 0·45–0·83)。多位点测序分型显示存在多个进化树,CRE和CSE菌株间仅有很少的重叠。

Interpretation 结论

Carbapenem resistance is associated with increased length of hospital stay and mortality in patients with bloodstream infections in LMICs. These data will inform global estimates of the burden of antimicrobial resistance and reinforce the need for better strategies to prevent, diagnose, and treat CRE infections in LMICs.

碳青霉烯耐药伴随LMICs血行性感染患者住院日延长及病死率增加。这些数据为了解抗生素耐药的全球负担提供了资料,强调了需要更好策略以预防、诊断和治疗LMICs的CRE感染。

Funding

bioMérieux.

给我留言

您必须 [ 登录 ] 才能发表留言!

×
腾讯微博