鲍曼不动杆菌
医学
危险系数
碳青霉烯
抗生素
比例危险模型
内科学
回顾性队列研究
重症监护室
重症监护医学
微生物学
置信区间
铜绿假单胞菌
细菌
生物
遗传学
作者
L. Silvia Munoz‐Price,Rossana Rosa,José G. Castro,Panthipa Laowansiri,Rachel Latibeaudiere,Nicholas Namias,Sergey Tarima
标识
DOI:10.1097/ccm.0000000000001848
摘要
Objectives: To determine the time-dependent effect of antibiotics on the initial acquisition of carbapenem-resistant Acinetobacter baumannii . Design: Retrospective cohort study. Setting: Forty-bed trauma ICU in Miami, FL. Patients: All consecutive patients admitted to the unit from November 1, 2010, to November 30, 2011. Interventions: None. Measurements and Main Results: Patients underwent surveillance cultures at admission to the unit and weekly thereafter. The primary outcome was the acquisition of carbapenem-resistant A. baumannii on surveillance cultures. Daily antibiotic exposures during the time of observation were used to construct time-dependent variables, including cumulative exposures (in grams and daily observed doses [defined daily doses]). Among 360 patients, 45 (12.5%) became colonized with carbapenem-resistant A. baumannii . Adjusted Cox models showed that each additional point in the Acute Physiologic and Chronic Health Evaluation score increased the hazard by 4.8% (hazard ratio, 1.048; 95% CI, 1.010–1.087; p = 0.0124) and time-dependent exposure to carbapenems quadrupled the hazard (hazard ratio, 4.087; 95% CI, 1.873–8.920; p = 0.0004) of acquiring carbapenem-resistant A. baumannii . Additionally, adjusted Cox models determined that every additional carbapenem defined daily dose increased the hazard of acquiring carbapenem-resistant A. baumannii by 5.1% (hazard ratio, 1.051; 95% CI, 1.007–1.093; p = 0.0243). Conclusions: Carbapenem exposure quadrupled the hazards of acquiring A. baumannii even after controlling for severity of illness.
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