TY - JOUR
T1 - Risk factors and outcomes of infections caused by extremely drug-resistant gram-negative bacilli in patients hospitalized in intensive care units
AU - Patel, Sameer J.
AU - Oliveira, André P.
AU - Zhou, Juyan Julia
AU - Alba, Luis
AU - Furuya, E. Yoko
AU - Weisenberg, Scott A.
AU - Jia, Haomiao
AU - Clock, Sarah A.
AU - Kubin, Christine J.
AU - Jenkins, Stephen G.
AU - Schuetz, Audrey N.
AU - Behta, Maryam
AU - Della-Latta, Phyllis
AU - Whittier, Susan
AU - Rhee, Kyu
AU - Saiman, Lisa
N1 - Funding Information:
Supported by the Centers for Disease Control and Prevention ( R01 CI000537 ), the National Institute of Nursing Research ( T90 NR010824 ; to S.A.C.), and the Clinical and Translation Science Center at Weill Cornell Medical College ( KL2RR024997 ; to S.A.W.).
PY - 2014/6
Y1 - 2014/6
N2 - Background Extremely drug-resistant gram-negative bacilli (XDR-GNB) increasingly cause health care-associated infections (HAIs) in intensive care units (ICUs). Methods A matched case-control (1:2) study was conducted from February 2007 to January 2010 in 16 ICUs. Case and control subjects had HAIs caused by GNB susceptible to ≤1 antibiotic versus ≥2 antibiotics, respectively. Logistic and Cox proportional hazards regression assessed risk factors for HAIs and predictors of mortality, respectively. Results Overall, 103 case and 195 control subjects were enrolled. An immunocompromised state (odds ratio [OR], 1.55; P =.047) and exposure to amikacin (OR, 13.81; P <.001), levofloxacin (OR, 2.05; P =.005), or trimethoprim-sulfamethoxazole (OR, 3.42; P =.009) were factors associated with XDR-GNB HAIs. Multiple factors in both case and control subjects significantly predicted increased mortality at different time intervals after HAI diagnosis. At 7 days, liver disease (hazard ratio [HR], 5.52), immunocompromised state (HR, 3.41), and bloodstream infection (HR, 2.55) predicted mortality; at 15 days, age (HR, 1.02 per year increase), liver disease (HR, 3.34), and immunocompromised state (HR, 2.03) predicted mortality; and, at 30 days, age (HR, 1.02 per 1-year increase), liver disease (HR, 3.34), immunocompromised state (HR, 2.03), and hospitalization in a medical ICU (HR, 1.85) predicted mortality. Conclusion HAIs caused by XDR-GNB were associated with potentially modifiable factors. Age, liver disease, and immunocompromised state, but not XDR-GNB HAIs, were associated with mortality.
AB - Background Extremely drug-resistant gram-negative bacilli (XDR-GNB) increasingly cause health care-associated infections (HAIs) in intensive care units (ICUs). Methods A matched case-control (1:2) study was conducted from February 2007 to January 2010 in 16 ICUs. Case and control subjects had HAIs caused by GNB susceptible to ≤1 antibiotic versus ≥2 antibiotics, respectively. Logistic and Cox proportional hazards regression assessed risk factors for HAIs and predictors of mortality, respectively. Results Overall, 103 case and 195 control subjects were enrolled. An immunocompromised state (odds ratio [OR], 1.55; P =.047) and exposure to amikacin (OR, 13.81; P <.001), levofloxacin (OR, 2.05; P =.005), or trimethoprim-sulfamethoxazole (OR, 3.42; P =.009) were factors associated with XDR-GNB HAIs. Multiple factors in both case and control subjects significantly predicted increased mortality at different time intervals after HAI diagnosis. At 7 days, liver disease (hazard ratio [HR], 5.52), immunocompromised state (HR, 3.41), and bloodstream infection (HR, 2.55) predicted mortality; at 15 days, age (HR, 1.02 per year increase), liver disease (HR, 3.34), and immunocompromised state (HR, 2.03) predicted mortality; and, at 30 days, age (HR, 1.02 per 1-year increase), liver disease (HR, 3.34), immunocompromised state (HR, 2.03), and hospitalization in a medical ICU (HR, 1.85) predicted mortality. Conclusion HAIs caused by XDR-GNB were associated with potentially modifiable factors. Age, liver disease, and immunocompromised state, but not XDR-GNB HAIs, were associated with mortality.
KW - Antibiotic resistance
KW - Gram-negative bacteria
KW - Health care-associated infection
KW - Mortality
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U2 - 10.1016/j.ajic.2014.01.027
DO - 10.1016/j.ajic.2014.01.027
M3 - Article
C2 - 24725516
AN - SCOPUS:84901241043
VL - 42
SP - 626
EP - 631
JO - American Journal of Infection Control
JF - American Journal of Infection Control
SN - 0196-6553
IS - 6
ER -