Association between mortality and highly antimicrobial-resistant bacteria in intensive care unit-acquired pneumonia

Abstract

Data on the relationship between antimicrobial resistance and mortality remain scarce, and this relationship needs to be investigated in intensive care units (ICUs). The aim of this study was to compare the ICU mortality rates between patients with ICU-acquired pneumonia due to highly antimicrobial-resistant (HAMR) bacteria and those with ICU-acquired pneumonia due to non-HAMR bacteria. We conducted a multicenter, retrospective cohort study using the French National Surveillance Network for Healthcare Associated Infection in ICUs (“REA-Raisin”) database, gathering data from 200 ICUs from January 2007 to December 2016. We assessed all adult patients who were hospitalized for at least 48 h and presented with ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii. The association between pneumonia caused by HAMR bacteria and ICU mortality was analyzed using the whole sample and using a 1:2 matched sample. Among the 18,497 patients with at least one documented case of ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii, 3081 (16.4%) had HAMR bacteria. The HAMR group was associated with increased ICU mortality (40.3% vs. 30%, odds ratio (OR) 95%, CI 1.57 [1.45–1.70], P < 0.001). This association was confirmed in the matched sample (3006 HAMR and 5640 non-HAMR, OR 95%, CI 1.39 [1.27–1.52], P < 0.001) and after adjusting for confounding factors (OR ranged from 1.34 to 1.39, all P < 0.001). Our findings suggest that ICU-acquired pneumonia due to HAMR bacteria is associated with an increased ICU mortality rate, ICU length of stay, and mechanical ventilation duration.

The Relationship Between Positive Cultures With Multidrug-Resistant Microorganisms and Mortality in a General Intensive Care Unit

“…In the present study, it was observed that positive culture related to the respiratory tract increases mortality, which corroborates with the results of previous studies (25,30). Bonnet et al (16) demonstrated that 51.7% of patients with lung infections died and pulmonary infections increased the length of stay (P > 0.001).…”

“…In our study, in-hospital mortality was 35.5%. The ICU mortality was reported at 40.3% in patients with antimicrobial resistance infections in the study of Lakbar et al (25), which is compatible with the results of Colpan et al (24).…”

Clinical Features and Outcomes of Monobacterial and Polybacterial Episodes of Ventilator-Associated Pneumonia Due to Multidrug-Resistant Acinetobacter baumannii

“…The effect of the drug resistance profile of A. baumannii strains on mortality remains unclear. A large study by Lakbar et al [ 10 ] that analyzed the association between antibiotic resistance and mortality in ICU-acquired pneumonia found that higher resistance of the causative pathogens increased the risk of death. On the contrary, Paramythiotou et al [ 59 ] did not confirm the link between higher resistance of GNBs as VAP pathogens and increased mortality.…”

“…It has established a niche in the hospital environment causing a variety of severe infections, especially in the critical care setting. It is usually a difficult-to-treat pathogen displaying a high resistance profile and has been associated with high mortality, morbidity, and health care costs [ 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ]. Although some controversy exists in the relevant literature, it seems that the high mortality of infections caused by multidrug-resistant (MDR) pathogens may be related not only to the bacterial resistance but also to the severity of illness and the appropriateness and timeliness of antibacterial treatment [ 1 , 5 , 8 , 9 , 10 , 11 , 12 ].…”

Incidence and outcomes of secondary infections in septic patients with cancer

“…[1] Critically ill patients are at a high risk of developing ventilatorassociated pneumonia (VAP) and bloodstream infections (BSIs), which are associated with increased ICU mortality. [2] Cancer patients are susceptible to infections owing to multiple risk factors due to immunosuppression, including radiotherapy, systemic therapy, and immunotherapy. [3,4] Hence, critically ill cancer patients with sepsis are also prone to developing secondary infections.…”