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【medical-news】耐甲氧苯青霉素金黄色葡萄球菌的
Background: Methicillin-resistant Staphylococcus aureus causes significant morbidity and mortality. Initially inappropriate antibiotic therapy for methicillin-resistant S. aureus increases the risk for mortality. The impact of initially inappropriate antibiotic therapy on hospital length of stay and costs remains unknown.
Methods: We identified patients admitted with nonnosocomial methicillin-resistant S. aureus sterile-site infections during a 3 yr period and compared those given appropriate antibiotic therapy with those given initially inappropriate antibiotic therapy. Appropriate therapy was defined based on timely administration of an anti-infective to which the pathogen was in vitro susceptible. Hospital length of stay served as the primary end point whereas total hospital costs represented a secondary end point. We attempted to adjust for multiple potential confounders including demographics, comorbid illnesses, infection characteristics, and severity of illness. We conducted subgroup analyses in patients who survived their hospital stay and in those requiring admission to the intensive care unit.
Results: The cohort included 291 patients and 77% received initially inappropriate antibiotic therapy. Approximately one in five patients died during their hospitalization. The median length of stay among the appropriately treated population was 2 days shorter than those given initially inappropriate antibiotic therapy (7.1 vs. 9.3 days, p = .050). After adjusting for covariates in a Cox proportional hazards model, initially appropriate therapy remained associated with a reduced length of stay (hazard ratio: 0.69, 95% confidence interval: 0.51-0.92, p = .013). Median crude costs in those treated appropriately were $13,688 compared with $19,427 (p = .019). Restricting the analysis to either hospital survivors or to those needing intensive care did not alter our observations.
Conclusion: Initially inappropriate antibiotic therapy for methicillin-resistant S. aureus prolongs length of stay and increases hospital costs. Efforts to lower rates of initially inappropriate antibiotic therapy for methicillin-resistant S. aureus sterile-site infections will likely improve outcomes for both patients and for healthcare institutions. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 Inappropriate therapy for methicillin-resistant Staphylococcus aureus: Resource utilization and cost implications.
耐甲氧西林金黄色葡萄球菌（MRSA）的不恰当治疗：资源利用和相关费用
Background: Methicillin-resistant Staphylococcus aureus causes significant morbidity and mortality. Initially inappropriate antibiotic therapy for methicillin-resistant S. aureus increases the risk for mortality. The impact of initially inappropriate antibiotic therapy on hospital length of stay and costs remains unknown.
背景：耐甲氧西林金黄色葡萄球菌（MRSA）感染的发病率和病死率很高。不恰当的初始抗生素治疗会导致其病死率增加，但对患者住院天数及相关费用的影响尚不清楚。
Methods: We identified patients admitted with nonnosocomial methicillin-resistant S. aureus sterile-site infections during a 3 yr period and compared those given appropriate antibiotic therapy with those given initially inappropriate antibiotic therapy. Appropriate therapy was defined based on timely administration of an anti-infective to which the pathogen was in vitro susceptible.
方法：我们将3年内被确诊为院内MRSA感染的患者选择入组，并分为恰当抗生素治疗和初始不恰当抗生素治疗两组进行比较。定义恰当治疗为：对体外药敏试验结果所示病原菌给予及时的抗感染治疗。
Hospital length of stay served as the primary end point whereas total hospital costs represented a secondary end point. We attempted to adjust for multiple potential confounders including demographics, comorbid illnesses, infection characteristics, and severity of illness. We conducted subgroup analyses in patients who survived their hospital stay and in those requiring admission to the intensive care unit.
研究确定患者住院天数为首要终点，总费用为次要终点，对人口特征、合并疾病、感染类型及疾病严重程度等潜在混杂因素进行了校正，并对医院幸存者和需要入住ICU的患者进行了分组分析
Results: The cohort included 291 patients and 77% received initially inappropriate antibiotic therapy. Approximately one in five patients died during their hospitalization. The median length of stay among the appropriately treated population was 2 days shorter than those given initially inappropriate antibiotic therapy (7.1 vs. 9.3 days, p = .050). After adjusting for covariates in a Cox proportional hazards model, initially appropriate therapy remained associated with a reduced length of stay (hazard ratio: 0.69, 95% confidence interval: 0.51-0.92, p = .013). Median crude costs in those treated appropriately were $13,688 compared with $19,427 (p = .019). Restricting the analysis to either hospital survivors or to those needing intensive care did not alter our observations.
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作者:admin@医学,生命科学 2011-02-20 17:12
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