Predictors of mortality in patients with infections due to multi-drug resistant Gram negative bacteria: The study, the patient, the bug or the drug?

Vardakas, Konstantinos Z.; Rafailidis, Petros I.; Konstantelias, Athanasios A.; Falagas, Matthew E.

doi:10.1016/j.jinf.2012.10.028

Cited by 158 publications

(132 citation statements)

References 62 publications

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“…In a meta-analysis that included 30 studies of the predictors of mortality for nosocomial infections caused by MDR gram-negative bacteria, Vardakas et al found that septic shock, length of ICU stay, pneumonia, isolation of MDR species, inappropriate empirical and definitive therapy, and male sex were associated with increased mortality, whereas polymicrobial infections and cancer were not associated with death. 30 In contrast, our univariate analysis detected a tendency toward an association between polymicrobial BSIs, SAPS II, and in-hospital mortality; in the multivariate analysis, heart disease and having a BSI from K pneumoniae were significantly associated with death. We did not detect significant associations with death for cancer, hypertension, diabetes, renal failure, chronic obstructive pulmonary disease, male sex, postsurgical admission, trauma and mortality, and other noneK pneumoniae bacterial isolates, including carbapenem-resistant Acinetobacter spp and Pseudomonas spp.…”

Section: Discussioncontrasting

confidence: 86%

Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals

Rose¹,

Sordillo²,

Gini³

et al. 2015

American Journal of Infection Control

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Section: Discussioncontrasting

confidence: 86%

Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals

Rose¹,

Sordillo²,

Gini³

et al. 2015

American Journal of Infection Control

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“…Although not designed with this end point in mind, our crude mortality for both resistant infections in our study was between 32% and 35%. These rates are similar to those ranges reported in the literature [8,11,12]. These findings are somewhat conflicting and suggest that perhaps our grading scale overestimates the degree of cross-transmission.…”

Section: Discussionsupporting

confidence: 86%

Whence Resistance?

Guidry

Davies

Metzger

et al. 2015

Surgical Infections

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Background: Antimicrobial resistance results from a complex interaction between pathogenic and non-pathogenic bacteria, antimicrobial pressure, and genes, which together comprise the total body of potential resistance elements. The purpose of this study is to review and evaluate the importance of antimicrobial pressure on the development of resistance in a single surgical intensive care unit. Methods: We reviewed a prospectively collected dataset of all intensive care unit (ICU)-acquired infections in surgical and trauma patients over a 6-y period at a single hospital. Resistant gram-negative pathogens (rGNR) included those resistant to all aminoglycosides, quinolones, penicillins, cephalosporins, or carbapenems; resistant gram-positive infections (rGPC) included methicillin-resistant Staphylococcus aureus (MRSA) or vancomycinresistant enterococci (VRE). Each resistant infection was evaluated for prior or concomitant antibiotic use, previous treatment for the same (non-resistant) organism, and concurrent infection with the same organism (genus and species, although not necessarily resistant) in another ICU patient. Results: Three hundred and thirty resistant infections were identified: 237 rGNR and 93 rGPC. Infections with rGNR occurred frequently while receiving antibiotic therapy (65%), including the sensitive form of the subsequent resistant pathogen (42.2%). Infections with rGPC were also likely to occur on antimicrobial therapy (50.6%). Treatment of a different patient for an infection with the same resistant pathogen in the ICU at the time of diagnosis, implying potential patient-to-patient transmission occurred more frequently with rGNR infections (38.8%). Conclusion: Antimicrobial pressure exerts a substantial effect on the development of subsequent infection. Our data demonstrate a high estimated rate of de novo emergence of resistance after treatment, which appears to be more common than patient-to-patient transmission. These data support the concept that efforts to limit antimicrobial usage will be more efficacious than enhanced isolation procedures when trying to reduce antimicrobial resistance.

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“…A recent meta-analysis also demonstrated that MDR status was an important determinant of mortality due to nosocomial infections attributed to gram-negative bacteria, where P. aeruginosa and Acinetobacter species were the most common isolates. 34 It is also interesting that the observed mortality for COP was lower than that observed more than 10 years ago despite the high rate of bacteremia, suggesting that these may have been less virulent strains of gram-negative bacteria. 35 The high rates of MDR and IIAT in Pa-NP for all pneumonia types mandate that clinicians have therapeutic strategies in place to optimize therapy.…”

Section: Discussionmentioning

confidence: 89%

Pseudomonas aeruginosaNosocomial Pneumonia: Impact of Pneumonia Classification

Micek

Kollef

Torres

et al. 2015

Infect. Control Hosp. Epidemiol.

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OBJECTIVETo describe and compare the mortality associated with nosocomial pneumonia due to Pseudomonas aeruginosa (Pa-NP) according to pneumonia classification (community-onset pneumonia [COP], hospital-acquired pneumonia [(HAP], and ventilator-associated pneumonia [VAP]).DESIGNWe conducted a retrospective cohort study of adults with Pa-NP. We compared mortality for Pa-NP among patients with COP, HAP, and VAP and used logistic regression to identify risk factors for hospital mortality and inappropriate initial antibiotic therapy (IIAT).SETTINGTwelve acute care hospitals in 5 countries (United States, 3; France, 2; Germany, 2; Italy, 2; and Spain, 3).PATIENTS/PARTICIPANTSA total of 742 patients with Pa-NP.RESULTSHospital mortality was greater for those with VAP (41.9%) and HAP (40.1%) compared with COP (24.5%) (P<.001). In multivariate analyses, independent predictors of hospital mortality differed by pneumonia classification (COP: need for mechanical ventilation and intensive care; HAP: multidrug-resistant isolate; VAP: IIAT, increasing age, increasing Charlson comorbidity score, bacteremia, and use of vasopressors). Presence of multidrug resistance was identified as an independent predictor of IIAT for patients with COP and HAP, whereas recent antibiotic administration was protective in patients with VAP.CONCLUSIONSAmong patients with Pa-NP, pneumonia classification identified patients with different risks for hospital mortality. Specific risk factors for hospital mortality also differed by pneumonia classification and multidrug resistance appeared to be an important risk factor for IIAT. These findings suggest that pneumonia classification for P. aeruginosa identifies patients with different mortality risks and specific risk factors for outcome and IIAT.Infect Control Hosp Epidemiol 2015;36(10):1190–1197

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Predictors of mortality in patients with infections due to multi-drug resistant Gram negative bacteria: The study, the patient, the bug or the drug?

Cited by 158 publications

References 62 publications

Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals

Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients: A 1-year, large, prospective surveillance study in 5 Italian hospitals

Whence Resistance?

Pseudomonas aeruginosaNosocomial Pneumonia: Impact of Pneumonia Classification

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