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Abstract：
We hypothesized that quick Sequential Organ Failure Assessment (qSOFA) would be associated with 30-day mortality in bacteremia caused by extended-spectrum β-lactamase (ESBL)-producing bacteria and might be a selection criterion for the use of carbapenem as initial empirical therapy. A multicenter retrospective study was conducted in six hospitals. All patients who had bacteremia due to ESBL-producing bacteria were included in the study. Multivariable logistic regression analysis was performed to analyze 30-day mortality as the main outcome. A total of 203 adult patients were identified with bacteremia caused by ESBL-producing Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis. In multivariate logistic regression analysis, bacteremia caused by ESBL-producing K. pneumoniae or P. mirabilis (odds ratio [OR] 5.07, 95% confidence interval [CI] 1.64-15.56), underlying liver disease (OR 3.38, 95% CI 1.09-10.00), and underlying solid cancer (OR 3.45, 95% CI 1.27-9.69) were associated with 30-day mortality. In a subgroup analysis, empirical non-carbapenem therapy was associated with 30-day mortality in bacteremia caused by ESBL-producing K. pneumoniae or P. mirabilis. Our results suggest that the qSOFA score is not a selection criterion for the use of carbapenem in initial empirical therapy.
摘要：
我们假设快速序贯器官衰竭评估（qSOFA）与产超广谱β-内酰胺酶（ESBL）细菌引起的菌血症30天死亡率相关，可能是碳青霉烯作为初始经验疗法的选择标准。在六家医院进行了多中心回顾性研究。所有因产生ESBL的细菌而出现菌血症的患者均纳入研究。进行多变量逻辑回归分析，以30天死亡率为主要结果。共有203名成年患者被确定为由产生ESBL的大肠杆菌引起的菌血症，肺炎克雷伯菌,或者变形杆菌.在多变量逻辑回归分析中，由产生ESBL的肺炎克雷伯菌或奇异假单胞菌引起的菌血症（比值比[OR]5.07，95％置信区间[CI]1.64-15.56），基础肝病（OR3.38，95%CI1.09-10.00），和基础实体癌(OR3.45,95%CI1.27-9.69)与30天死亡率相关.在亚组分析中，经验性非碳青霉烯治疗与产ESBL肺炎克雷伯菌或奇异假单胞菌引起的菌血症30天死亡率相关.我们的结果表明，qSOFA评分不是在初始经验治疗中使用碳青霉烯的选择标准。
