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https://ir.cnu.edu.tw/handle/310902800/31074
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| 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 |
| 顯示於類別: | [醫務管理系(所)] 期刊論文
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