Risk factors and outcomes of infections caused by extremely drug-resistant gram-negative bacilli in patients hospitalized in intensive care units

Sameer J. Patel*, André P. Oliveira, Juyan Julia Zhou, Luis Alba, E. Yoko Furuya, Scott A. Weisenberg, Haomiao Jia, Sarah A. Clock, Christine J. Kubin, Stephen G. Jenkins, Audrey N. Schuetz, Maryam Behta, Phyllis Della-Latta, Susan Whittier, Kyu Rhee, Lisa Saiman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

25 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)626-631
Number of pages6
JournalAmerican Journal of Infection Control
Volume42
Issue number6
DOIs
StatePublished - Jun 2014

Keywords

  • Antibiotic resistance
  • Gram-negative bacteria
  • Health care-associated infection
  • Mortality

ASJC Scopus subject areas

  • Epidemiology
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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