Mortality attributable to hospital acquired infections with multidrug-resistant bacteria in a large group of German hospitals

Neubeiser, Alicia; Bonsignore, Marzia; Tafelski, Sascha; Alefelder, Christof; Schwegmann, Karin; Rüden, H.; Geffers, Christine; Nachtigall, Irit

doi:10.1016/j.jiph.2019.07.025

Cited by 23 publications

(15 citation statements)

References 15 publications

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“…26,27 It is known that multidrug resistant bacteria are a major health care problem and associated with increased mortality, however, only a small fraction of deaths have been directly attributed to them in infected patients by previous studies. 28,29 Interestingly, our study found no significant difference in mortality based on site of infection, type of infecting pathogen or antibiotic resistance. Given the limited number of patients with multiple infections during the same hospitalization, our study may be underpowered to detect a mortality difference based on number of HAIs.…”

Section: Discussioncontrasting

confidence: 53%

“…Finally, an analysis on the appropriateness of the given antibiotics would have been of great value to this study, especially because a tendency of greater infection rates with multiresistant pathogens has been independently associated with use of certain antibiotics. 29 Unfortunately, given the low number of individuals with recorded data matching identification of specific pathogens, the antimicrobials used and the drug resistance profile, we could not perform analyses separating such categories.…”

Section: Discussionmentioning

confidence: 99%

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<p>Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections</p>

Otero¹,

Menezes²,

Ferreira³

et al. 2020

IDR

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Evaluate host and pathogen factors associated with mortality in those with hospital acquired infections (HAI) in a tertiary intensive care unit in Brazil. Methods: Observational and analytical cohort single center study in a general intensive care unit (ICU) in Northeastern Brazil between January 2016 and August 2018, including those over 18 years of age admitted to the ICU found to have a HAI. Results: A total of 165 patients were included, with a mean age of 72 years and male predominance (53.3%) and observed mortality of 46%. Mortality in those with HAI was significantly associated with older age, increased ICU length of stay and readmission to the ICU in univariate analysis. Multivariate analysis revealed that development of septic shock and obtundation during ICU admission was significantly associated with an increased risk of death (OR: 6.94, 95% CI 1.23-39.27, OR: 2.48, 95% CI 1.17-5.29, respectively). A trend towards mortality risk was noted in those with increased age and prior cardiovascular disease. Surprisingly, mortality risk was independent of site of infection, type of pathogen and antibiotic resistance. Furthermore, having more than one HAI over the course of the ICU admission did not impact mortality. Conclusion: Risk of death in those with HAI is associated with obtundation and septic shock, in addition to vasopressor use. Host factors, rather than pathogen-specific characteristics or infecting site, impact risk of death related to HAI in the ICU.

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Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 99%

<p>Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections</p>

Otero¹,

Menezes²,

Ferreira³

et al. 2020

IDR

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“…Previous studies that found a higher risk of infection with antibiotic-resistant pathogens for men came to varying conclusions: while some studies suggested underlying biological mechanisms as the cause [ 18 ], others proposed differences in antibiotic prescribing [ 19 ], or poorer compliance of men with hand-hygiene recommendations [ 9 ]. Furthermore, men were found to be more likely to be affected by hospital-acquired infections [ 20 , 21 ], which may be caused by higher hospitalisation rates, especially in older age groups. By using full-time inpatients as an alternate population, we deemed all infections and colonisations to be hospital-acquired.…”

Section: Discussionmentioning

confidence: 99%

Bugs That Can Resist Antibiotics but Not Men: Gender-Specific Differences in Notified Infections and Colonisations in Germany, 2010–2019

et al. 2021

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Data from surveillance networks show that men have a higher incidence rate of infections with anti-microbial-resistant (AMR) pathogens than women. We systematically analysed data of infections and colonisations with AMR pathogens under mandatory surveillance in Germany to quantify gender-specific differences. We calculated incidence-rates (IR) per 100,000 person–years for invasive infections with Methicillin-resistant Staphylococcus aureus (MRSA), and for infections or colonisations with carbapenem-non-susceptible Acinetobacter spp. (CRA), and Enterobacterales (CRE), using the entire German population as a denominator. We limited the study periods to years with complete notification data (MRSA: 2010–2019, CRA/CRE: 2017–2019). We used Poisson regression to adjust for gender, age group, federal state, and year of notification. In the study periods, IR for all notifications were 4.2 for MRSA, 0.90 for CRA, and 4.8 for CRE per 100,000 person-–years. The adjusted IR ratio for infections of men compared to women was 2.3 (95% confidence interval [CI]: 2.2–2.3) for MRSA, 2.2 (95%CI: 1.9–2.7) for CRA, and 1.7 (95%CI: 1.6–1.8) for CRE. Men in Germany show about double the risk for infection with AMR pathogens than women. This was also true for colonisations, where data were available. Screening procedures and associated hygiene measures may profit from a gender-stratified approach.

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“…The higher AMR rate in this population of deceased patients with HAI seems to be associated with death as AMR was perceived as definitely or possibly contributing to death in 70-72% of these patients. In a German mortality review of 215 patients deceased with a multidrug-resistant hospital-acquired infection the infection was considered the cause of death in 36% [26], which is slightly higher than the 28-30% of our cases where contribution of (not necessarily multidrug) resistance was considered definite. Overall, antimicrobial treatment was considered inadequate in 15% of the cases, in the lower ranges of what has been reported elsewhere [27].…”

Section: Discussionmentioning

confidence: 76%

Mortality review as a tool to assess the contribution of healthcare-associated infections to death: results of a multicentre validity and reproducibility study, 11 European Union countries, 2017 to 2018

Kooi

Lepape²,

Astagneau³

et al. 2021

Eurosurveillance

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Introduction The contribution of healthcare-associated infections (HAI) to mortality can be estimated using statistical methods, but mortality review (MR) is better suited for routine use in clinical settings. The European Centre for Disease Prevention and Control recently introduced MR into its HAI surveillance. Aim We evaluate validity and reproducibility of three MR measures. Methods The on-site investigator, usually an infection prevention and control doctor, and the clinician in charge of the patient independently reviewed records of deceased patients with bloodstream infection (BSI), pneumonia, Clostridioides difficile infection (CDI) or surgical site infection (SSI), and assessed the contribution to death using 3CAT: definitely/possibly/no contribution to death; WHOCAT: sole cause/part of causal sequence but not sufficient on its own/contributory cause but unrelated to condition causing death/no contribution, based on the World Health Organization’s death certificate; QUANT: Likert scale: 0 (no contribution) to 10 (definitely cause of death). Inter-rater reliability was assessed with weighted kappa (wk) and intra-cluster correlation coefficient (ICC). Reviewers rated the fit of the measures. Results From 2017 to 2018, 24 hospitals (11 countries) recorded 291 cases: 87 BSI, 113 pneumonia , 71 CDI and 20 SSI. The inter-rater reliability was: 3CAT wk 0.68 (95% confidence interval (CI): 0.61–0.75); WHOCAT wk 0.65 (95% CI: 0.58–0.73); QUANT ICC 0.76 (95% CI: 0.71–0.81). Inter-rater reliability ranged from 0.72 for pneumonia to 0.52 for CDI. All three measures fitted ‘reasonably’ or ‘well’ in > 88%. Conclusion Feasibility, validity and reproducibility of these MR measures was acceptable for use in HAI surveillance.

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Mortality attributable to hospital acquired infections with multidrug-resistant bacteria in a large group of German hospitals

Cited by 23 publications

References 15 publications

<p>Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections</p>

<p>Factors Associated with Mortality in Critically Ill Patients Diagnosed with Hospital Acquired Infections</p>

Bugs That Can Resist Antibiotics but Not Men: Gender-Specific Differences in Notified Infections and Colonisations in Germany, 2010–2019

Mortality review as a tool to assess the contribution of healthcare-associated infections to death: results of a multicentre validity and reproducibility study, 11 European Union countries, 2017 to 2018

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