Study On The Distribution Characteristics And Risk Factors Of Death Of Multi-drug Resistant G~-bacteria Bloodstream Infection Pathogens

Background:The study was to describe the profile of patients and the characteristics of all multidrug-resistant Gram-negative bacteria(MDR-GNB)and to assess the mortality.Methods:We conducted a retrospective study of 138 patients with bloodstream infections(BSIs)caused by MDR-GNB between 1 January 2013 and 31 December 2016 at the First Affiliated Hospital of Nanjing Medical University.Data on demographic and clinical characteristics,wards,invasive,medieal procedures,bacterial resistance to antibiotics,underlying diseases,acute physiology and chronic health evaluation II(APACHE II)score in the beginning were collected.According to the in-hospital mortality after admission,the patients were divided into survivor(n=103)and nonsurvivor(n=35).Survivor and nonsurvivor subgroups were compared to identify predictors of mortality by univariate analysis and cox regression analysis.Kaplan-Meier curves showed the impact of combination therapy versus monotherapy on in-hospital mortality of patients with MDR-GNB bloodstream infections.All statistical description and analysis was conducted by SPSS 22.0.Results:We have collected 138 patients with MDR-GNB bloodstream infections,of which the number of patients with carbapenem-resistant enterobacteriaceae(CRE)bloodstream infections was 33,the number of carbapenem-resistant acinetobacter baumannii(CR-AB)was 83 and the number of multidrug-resistant pseudomonas aeruginosa(MDR-PA)was 22.The in-hospital mortality rate was 25.4%.Univariate analysis revealed the comorbidities,previous hospitalization during the 12 months preceding BSI onset,previous antibiotic therapy during the 30 days preceding BSI onset and inadequate initial antimicrobial treatment could increase risk of death.In Cox regression analysis,mortality was independently associated with the age(P ?0.034),hospitalization of intensive care unit(ICU)(P = 0.04),invasive procedures(P<0.001)and APACHE II scores(P<0.001),whereas combination therapy,monotherapy or MDR-GNB strains was not associated with mortality(P>0.05).Postantibiogram therapy with a combination was associated with hospitalization of ICU,Charlson comorbidity score<4,inadequate initial antimicrobial treatment(P<0.05).The survival distributions of monotherapy vs combination therapy were also not significantly different in patients with bloodstream infections caused by CRE and MDR-PA.But the survival distributions were significantly different in patients with BSIs caused by CR-AB treated with monotherapy vs combination therapy regimens(P = 0.02).Conclusions:The in-hospital mortality rate of MDR-GNB bloodstream infections was high.MDR-GNB strains and antimicrobial regimens were not the major risk factors for mortality.The inadequate initial antibiotic,previous antibiotic therapy during the 30 days preceding BSI onset,invasive procedures,previous hospitalization during the 12 months preceding BSI onset,high APACHE ? scores,hospitalization of ICU,and comorbidities were the important factors responsible for mortality.Although there was no difference between combination therapy and monotherapy in mortality,combined treatment may be more effective than monotherapy for patients of ICU,Charlson comorbidity score<4 or inadequate initial antimicrobial treatment.Objectives:To investigate the SCI papers' research status of emergency medicine in China through literature search of international emergency medicine journals and retrospectively compare the outputs of emergency medicine articles of the three major regions of China-Mainland(ML),Taiwan(TW)and Hong Kong(HK).Methods:Emergency medicine journals were selected category from Science Citation Index Expand(SCIE).Articles from the ML,TW and HK were retrieved from Pubmed database.The total number of articles,publication types,research contents,impact factors(IF)and articles published in each journal were conducted for quantity and quality comparisons.Results:A total of 1760 articles from 19 emergency medicine journals were searched,of which 395 were from ML,1210 from TW,and 155 from HK.Accumulated IF of articles from TW(2451.109)was much higher than that of ML(851.832)and HK(328.579),while the average IF of articles from TW(2.02)was the lowest.The number of case reports was the highest,which was respective 69 from ML,637 from TW,and 25 from HK.Although emergency medicine was involved with multiple organs and multiple systems,the reports of trauma accounted for 25%and infection accounted for 8%of the research contents.Conclusions:The total number of articles from both China and the rest of the world increased significantly from 2000 to 2014,especially ML.The total number of articles from TW was still much more than that of ML and HK,while the quality of articles from TW was not as good as ML and HK.Case report had the highest share of publication types,while the proportions of meta-analysis and observational study were the lowest.As for research contents,the proportion of trauma and infection was still the highest.