Risk Factors for Antibiotic Resistance and Mortality in Nosocomial Gram-negative Bloodstream Infections: A Retrospective Study
Öz
Aim: The current increase in the rate of nosocomial infection caused
by the drug-resistant and multi-drug resistant (MDR) Gram-negative
bacteria rendered the current treatment options insufficient. In this
case-control study, we aimed to determine the risk factors for drug-resistance, multi-drug resistance and mortality in nosocomial bloodstream infections (NBSIs).
Material and Methods: The study included one hundred consecutive
patients aged 18 years and over with nosocomial bloodstream infections
caused by Gram-negative bacteria. Twenty-nine patients with multidrug-resistant Gram-negative bacteremia constituted the case group,
and 71 patients without MDR constituted the control group. Forty-four
patients who ended up with mortality formed the case group, and 56
patients who recovered formed the control group.
Results: Acinetobacter baumannii was isolated as the most common
causative microorganism. The mean age in the group with MDR bacteria-caused NBSI was significantly higher than in the non-MDR group
(p=0.02). Older age (Odds ratio [OR] = 1.0; 1.0-1.1; p=0.047), acute renal failure (ARF) (OR= 12.8; 2.7-58.7; p=0.001), use of cephalosporins
within the last month (OR= 15.8; 2.3-107.6; p=0.005), and A. baumannii as the causative agent (OR=6.1; 1.6-23.8; p=0.008) were independent risk factors for development of MDR bacteria-caused NBSI. In patients with Gram-negative bacteremia; malignancy (OR=7.7; 2.4-24.4;
p <0.001), high Eastern Cooperative Oncology Group (ECOG) score
(OR=2.9; 1.3-6.5; p=0.009), and high Acute Physiological and Chronic Health Evaluation II (APACHE II) score (OR=1.2; 1.1-1.3; p=0.001)
were found to be independent risk factors for mortality.
Discussion and Conclusion: The findings of the present study revealed
that advanced age, acute renal failure, and use of cephalosporins within
the last month were independent risk factors for multidrug resistance in
nosocomial Gram-negative bacteremia. The findings§ also revealed that
malignancy, high ECOG and APACHE II scores were independent risk
factors for mortality in patients with nosocomial Gram-negative bacteremia. Avoidance of empiric use of broad-spectrum cephalosporins
may limit resistance. In addition, considering existing risk factors when
initiating empiric therapy may prevent poor prognosis.
Anahtar Kelimeler
Nosocomial bloodstream infection, Gram-negative bacteria, multidrug-resistance, MDR.
Kaynakça
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