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    Please use this identifier to cite or link to this item: http://ir.cnu.edu.tw/handle/310902800/31074


    標題: Bacteremic Urinary Tract Infection Caused by Multidrug-Resistant Enterobacteriaceae Are Associated With Severe Sepsis at Admission Implication for Empirical Therapy
    作者: Lee, Yi-Chien
    Hsiao, Chih-Yen
    Hung, Miao-Chiu
    Hung, Sheng-Che
    Wang, Hung-Ping
    Huang, Yun-Jhong
    Wang, Jann-Tay
    貢獻者: Chia Yi Christian Hosp, Ditmanson Med Fdn, Dept Internal Med
    Chia Nan Univ Pharm & Sci, Dept Hosp & Hlth Care Adm
    Taipei Vet Gen Hosp, Dept Pediat
    Taipei Vet Gen Hosp, Dept Radiol
    Natl Yang Ming Univ, Sch Med
    Chia Yi Christian Hosp, Ditmanson Med Fdn, Dept Colorectal Surg
    Natl Taiwan Univ Hosp, Dept Internal Med
    關鍵字: escherichia-coli bacteremia
    risk-factors
    acute pyelonephritis
    antimicrobial resistance
    antibiotic-resistance
    clinical impact
    septic shock
    guidelines
    prognosis
    virulence
    日期: 2016-05
    上傳時間: 2018-01-18 11:41:11 (UTC+8)
    出版者: Lippincott Williams & Wilkins
    摘要: The purpose of this study is to compare the clinical features and treatment outcomes among patients with bacteremic urinary tract infection (UTI) caused by multidrug-resistant (MDR) and non-MDR Enterobacteriaceae and to identify whether MDR pathogens were independently associated with severe sepsis or septic shock at presentation. The clinical data of adult patients visiting and being treated at Chia-Yi Christian Hospital due to bacteremic UTI caused by Enterobacteriaceae from January 2006 to August 2015 were retrospectively analyzed. A total of 585 patientswere enrolled. Among them, 220 (37.6%) were caused by the MDR Enterobacteriaceae. A total of 206 patients (35.2%) developed severe sepsis or septic shock at presentation. Patients in the MDR group tend to be male and have a past history of gout, recurrent UTI, prior hospitalization, hydronephrosis, renal stone, ureteral stone, indwelling urinary catheter, newly development of renal dysfunction, severe sepsis or septic shock, intensive care unit (ICU) admission, receipt of ineffective empirical therapy, longer hospital stay, and higher in-hospital mortality (2.7% vs 1.9%, P = 0.569). Using multivariate logistic regression analysis, it is revealed that independent predictors associated with severe sepsis or septic shock at presentation were liver cirrhosis (OR 2.868; 95% CI 1.439-5.716; P = 0.003), indwelling urinary catheter (OR 1.936; 95% CI 1.238-3.027; P = 0.004), and MDR Enterobacteriaceae (OR 1.447; 95% CI 1.002-2.090; P = 0.049). Multidrug resistance was associated with the development of severe sepsis or septic shock upon presentation among patients with bacteremic UTI caused by Enterobacteriaceae. Therefore, empirical antibiotics therapy for patients with UTI presented with severe sepsis and/or septic shock should be more broad-spectrum to effectively cover MDR Enterobacteriaceae.
    關聯: Medicine, v.95 n.20, e3694
    Appears in Collections:[醫務管理系(所)] 期刊論文

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