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.|
Rising rates of carbapenem-resistant enterobacteriaceae in community hospitals: a mixed-methods review of epidemiology and microbiology practices in a network of community hospitals in the southeastern United States.
Prevalence of multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Enterobacteriaceae among specimens from hospitalized patients with pneumonia and bloodstream infections in the United States from 2000 to 2009.
|Journal Title||bmc infectious diseases|
|Publication Year Start||2017-01-01|
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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