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Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis.

Abstract Drug resistance among gram-negative pathogens is a risk factor for inappropriate empiric treatment (IET), which in turn increases the risk for mortality. We explored the impact of carbapenem-resistant Enterobacteriaceae (CRE) on the risk of IET and of IET on outcomes in patients with Enterobacteriaceae infections.
PMID
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Authors

Mayor MeshTerms
Keywords

Antimicrobial resistance

Enterobacteriaceae

Hospital cost

Hospital mortality

Inappropriate empiric therapy

Pneumonia

Sepsis

UTI

Journal Title bmc infectious diseases
Publication Year Start




PMID- 28415969
OWN - NLM
STAT- In-Process
DA  - 20170418
LR  - 20170421
IS  - 1471-2334 (Electronic)
IS  - 1471-2334 (Linking)
VI  - 17
IP  - 1
DP  - 2017 Apr 17
TI  - Carbapenem resistance, inappropriate empiric treatment and outcomes among
      patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia 
      and sepsis.
PG  - 279
LID - 10.1186/s12879-017-2383-z [doi]
AB  - BACKGROUND: Drug resistance among gram-negative pathogens is a risk factor for
      inappropriate empiric treatment (IET), which in turn increases the risk for
      mortality. We explored the impact of carbapenem-resistant Enterobacteriaceae
      (CRE) on the risk of IET and of IET on outcomes in patients with
      Enterobacteriaceae infections. METHODS: We conducted a retrospective cohort study
      in Premier Perspective database (2009-2013) of 175 US hospitals. We included all 
      adult patients with community-onset culture-positive urinary tract infection
      (UTI), pneumonia, or sepsis as a principal diagnosis, or as a secondary diagnosis
      in the setting of respiratory failure, treated with antibiotics within 2 days of 
      admission. We employed regression modeling to compute adjusted association of
      presence of CRE with risk of receiving IET, and of IET on hospital mortality,
      length of stay (LOS) and costs. RESULTS: Among 40,137 patients presenting to the 
      hospital with an Enterobacteriaceae UTI, pneumonia or sepsis, 1227 (3.1%) were
      CRE. In both groups, the majority of the cases were UTI (51.4% CRE and 54.3%
      non-CRE). Those with CRE were younger (66.6+/-15.3 vs. 69.1+/-15.9 years, p <
      0.001), and more likely to be African-American (19.7% vs. 14.0%, p < 0.001) than 
      those with non-CRE. Both chronic (Charlson score 2.0+/-2.0 vs. 1.9+/-2.1, p =
      0.009) and acute (by day 2: ICU 56.3% vs. 30.4%, p < 0.001, and mechanical
      ventilation 35.8% vs. 11.7%, p < 0.001) illness burdens were higher among CRE
      than non-CRE subjects, respectively. CRE patients were 3x more likely to receive 
      IET than non-CRE (46.5% vs. 11.8%, p < 0.001). In a regression model CRE was a
      strong predictor of receiving IET (adjusted relative risk ratio 3.95, 95%
      confidence interval 3.5 to 4.5, p < 0.001). In turn, IET was associated with an
      adjusted rise in mortality of 12% (95% confidence interval 3% to 23%), and an
      excess of 5.2 days (95% confidence interval 4.8, 5.6, p < 0.001) LOS and $10,312 
      (95% confidence interval $9497, $11,126, p < 0.001) in costs. CONCLUSIONS: In
      this large US database, the prevalence of CRE among patients with
      Enterobacteriaceae UTI, pneumonia or sepsis was comparable to other national
      estimates. Infection with CRE was associated with a four-fold increased risk of
      receiving IET, which in turn increased mortality, LOS and costs.
FAU - Zilberberg, Marya D
AU  - Zilberberg MD
AD  - EviMed Research Group, LLC, PO Box 303, Goshen, MA, 01032, USA.
      [email protected]
FAU - Nathanson, Brian H
AU  - Nathanson BH
AD  - OptiStatim, LLC, PO Box 60844, Longmeadow, MA, 01116, USA.
FAU - Sulham, Kate
AU  - Sulham K
AD  - The Medicines Company, 8 Sylvan Way, Parsippany, NJ, 07054, USA.
FAU - Fan, Weihong
AU  - Fan W
AD  - The Medicines Company, 8 Sylvan Way, Parsippany, NJ, 07054, USA.
FAU - Shorr, Andrew F
AU  - Shorr AF
AD  - Washington Hospital Center, 110 Irving St. NW, Washington, DC, 20010, USA.
LA  - eng
PT  - Journal Article
DEP - 20170417
PL  - England
TA  - BMC Infect Dis
JT  - BMC infectious diseases
JID - 100968551
PMC - PMC5393012
OTO - NOTNLM
OT  - Antimicrobial resistance
OT  - Enterobacteriaceae
OT  - Hospital cost
OT  - Hospital mortality
OT  - Inappropriate empiric therapy
OT  - Pneumonia
OT  - Sepsis
OT  - UTI
EDAT- 2017/04/19 06:00
MHDA- 2017/04/19 06:00
CRDT- 2017/04/19 06:00
PHST- 2016/11/17 [received]
PHST- 2017/04/05 [accepted]
AID - 10.1186/s12879-017-2383-z [doi]
AID - 10.1186/s12879-017-2383-z [pii]
PST - epublish
SO  - BMC Infect Dis. 2017 Apr 17;17(1):279. doi: 10.1186/s12879-017-2383-z.

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