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Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study

万古霉素耐药是否会增加原位肝移植术后屎肠球菌菌血症的死亡率?回顾性研究

  • 影响因子:3.2240
  • DOI:10.1186/s13756-020-0683-3
  • 作者列表:"S. Dubler","M. Lenz","S. Zimmermann","D. C. Richter","K. H. Weiss","A. Mehrabi","M. Mieth","T. Bruckner","M. A. Weigand","T. Brenner","A. Heininger
  • 发表时间:2020-02-02
Abstract

Abstract Background The relevance of vancomycin resistance in enterococcal blood stream infections (BSI) is still controversial. Aim of this study was to outline the effect of vancomycin resistance of Enterococcus faecium on the outcome of patients with BSI after orthotopic liver transplantation (OLT). Methods The outcome of OLT recipients developing BSI with vancomycin-resistant (VRE) versus vancomycin-susceptible Enterococcus faecium (VSE) was compared based on data extraction from medical records. Multivariate regression analyses identified risk factors for mortality and unfavourable outcomes (defined as death or prolonged intensive care stay) after 30 and 90 days. Results Mortality was similar between VRE- (n = 39) and VSE- (n = 138) group after 30 (p = 0.44) or 90 days (p = 0.39). Comparable results occurred regarding unfavourable outcomes. Mean SOFANon-GCS score during the 7-day-period before BSI onset was the independent predictor for mortality at both timepoints (HR 1.32; CI 1.14–1.53; and HR 1.18; CI 1.08–1.28). Timely appropriate antibiotic therapy, recent ICU stay and vancomycin resistance did not affect outcome after adjusting for confounders. Conclusion Vancomycin resistance did not influence outcome among patients with Enterococcus faecium bacteraemia after OLT. Only underlying severity of disease predicted poor outcome among this homogenous patient population. Trial registration This study was registered at the German clinical trials register (DRKS-ID: DRKS00013285).

摘要

摘要背景: 万古霉素耐药与肠球菌血流感染 (BSI) 的相关性仍存在争议。本研究的目的是概述屎肠球菌对万古霉素的耐药性对原位肝移植 (OLT) 后 BSI 患者预后的影响。方法根据病历资料提取,比较万古霉素耐药 (VRE) 与万古霉素敏感屎肠球菌 (VSE) OLT 受者发生 BSI 的结局。多变量回归分析确定了 30 天和 90 天后死亡率和不良结局 (定义为死亡或重症监护住院时间延长) 的危险因素。结果 30 后 VRE-(n = 39) 和 VSE-(n = 138) 组死亡率相似 (p = 0.44) 或 90 天 (p = 0.39)。关于不利结果出现了可比结果。BSI 发作前 7 天期间的平均 SOFANon-GCS 评分是两个时间点死亡率的独立预测因子 (HR 1.32; CI 1.14-1.53; HR 1.18; CI 1.08-1.28)。调整混杂因素后,及时适当的抗生素治疗、最近入住 ICU 和万古霉素耐药不影响结局。结论屎肠球菌菌血症患者 OLT 术后万古霉素耐药不影响预后。在这个同质患者人群中,只有潜在的疾病严重程度预测不良结局。试验注册本研究在德国临床试验注册中心 (DRKS-ID: DRKS00013285) 注册。

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影响因子:3.87
发表时间:2020-02-01
DOI:10.1111/liv.14321
作者列表:["Chen VL","Chen Y","Du X","Handelman SK","Speliotes EK"]

METHODS:BACKGROUND AND AIMS:Cirrhosis is characterized by extensive fibrosis of the liver and is a major cause of liver-related mortality. Cirrhosis is partially heritable but genetic contributions to cirrhosis have not been systemically explored. Here, we carry out association analyses with cirrhosis in two large biobanks and determine the effects of cirrhosis associated variants on multiple human disease/traits. METHODS:We carried out a genome-wide association analysis of cirrhosis as a diagnosis in UK BioBank (UKBB; 1088 cases vs. 407 873 controls) and then tested top-associating loci for replication with cirrhosis in a hospital-based cohort from the Michigan Genomics Initiative (MGI; 875 cases of cirrhosis vs. 30 346 controls). For replicating variants or variants previously associated with cirrhosis that also affected cirrhosis in UKBB or MGI, we determined single nucleotide polymorphism effects on all other diagnoses in UKBB (PheWAS), common metabolic traits/diseases and serum/plasma metabolites. RESULTS:Unbiased genome-wide association study identified variants in/near PNPLA3 and HFE, and candidate variant analysis identified variants in/near TM6SF2, MBOAT7, SERPINA1, HSD17B13, STAT4 and IFNL4 that reproducibly affected cirrhosis. Most affected liver enzyme concentrations and/or aspartate transaminase-to-platelet ratio index. PheWAS, metabolic trait and serum/plasma metabolite association analyses revealed effects of these variants on lipid, inflammatory and other processes including new effects on many human diseases and traits. CONCLUSIONS:We identified eight loci that reproducibly associate with population-based cirrhosis and define their diverse effects on human diseases and traits.

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影响因子:2.57
发表时间:2020-02-01
DOI:10.1111/eci.13198
作者列表:["Li H","Wieser A","Zhang J","Liss I","Markwardt D","Hornung R","Neumann-Cip AC","Mayerle J","Gerbes A","Steib CJ"]

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