Research Article
BibTex RIS Cite

Risk Factors for Antibiotic Resistance and Mortality in Nosocomial Gram-negative Bloodstream Infections: A Retrospective Study

Year 2022, Volume: 3 Issue: 2, 123 - 130, 30.04.2022

Abstract

References

  • 1. Abat C, Rolain JM, Dubourg G, Fournier PE, Chaudet H, Raoult D. Evaluating the Clinical Burden and Mortality Attributable to Antibiotic Resistance: The Disparity of Empirical Data and Simple Model Estimations. Clin Infect Dis. 2017;65:S58-63.
  • 2. Wu JN, Gan TE, Zhu YX, Cao JM, Ji CH, Wu YH, et al. Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study. J Zhejiang Univ Sci B. 2015;16:70-7
  • 3. Alp E, Damani N. Healthcare-associated infections in intensive care units: epidemiology and infection control in low-to-middle income countries. J Infect Dev Ctries. 2015;9:1040-5.
  • 4. Lark RL, Chenoweth C, Saint S, Zemencuk JK, Lipsky BA, Plorde JJ. Four year prospective evaluation of nosocomial bacteremia: epidemiology, microbiology, and patient outcome. Diagn Microbiol Infect Dis. 2000;38:131-40.
  • 5. Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis. 1999;29:239-44.
  • 6. Viscoli C. Bloodstream Infections: The peak of the iceberg. Virulence. 2016;7:248-51.
  • 7. Papanikolopoulou A, Maltezou HC, Gargalianos-Kakolyris P, Michou I, Kalofissoudis Y, Moussas N, et al. Central-line-associated bloodstream infections, multi-drug-resistant bacteraemias and infection control interventions: a 6-year time-series analysis in a tertiary care hospital in Greece. J Hosp Infect. 2022;123:27-33.
  • 8. Sadeghi H, Khoei SG, Bakht M, Rostamani M, Rahimi S, Ghaemi M, et al. A retrospective cross-sectional survey on nosocomial bacterial infections and their antimicrobial susceptibility patterns in hospitalized patients in northwest of Iran. BMC Res Notes. 2021;14:88.
  • 9. Lee CR, Cho IH, Jeong BC, Lee SH. Strategies to minimize antibiotic resistance. Int J Environ Res Public Health. 2013;10:4274-305.
  • 10. Blot S, Vandewoude K, De Bacquer D, Colardyn F. Nosocomial bacteremia caused by antibiotic-resistant Gram-negative bacteria in critically ill patients: clinical outcome and length of hospitalization. Clin Infect Dis. 2002;34:1600-6.
  • 11. Woolhouse M, Waugh C, Perry MR, Nair H. Global disease burden due to antibiotic resistance - state of the evidence. J Glob Health. 2016;6:010306.
  • 12. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39:309-17.
  • 13. Patterson JE, Hardin TC, Kelly CA, Garcia RC, Jorgensen JH. Association of antibiotic utilization measures and control of multiple-drug resistance in Klebsiella pneumoniae. Infect Control Hosp Epidemiol. 2000;21:455-8.
  • 14. Liu W, Guo T, Li H, Zhao Y, Zhang K, Hai Y, et al. Healthcare-associated infection prevention and control management in a tertiary hospital and an overall evaluation. Ann Palliat Med. 2020;9:1536-44.
  • 15. Young J, Badgery-Parker T, Dobbins T, Jorgensen M, Gibbs P, Faragher I, et al. Comparison of ECOG/WHO performance status and ASA score as a measure of functional status. J Pain Symptom Manage. 2015;49:258-64.
  • 16. Girard TD, Ely EW. Bacteremia and sepsis in older adults. Clin Geriatr Med. 2007;23:633-47.
  • 17. Haag-Weber M, Hörl WH. The immune system in uremia and during its treatment. New Horiz. 1995;3:669-79.
  • 18. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813-8.
  • 19. Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, et al. Bloodstream infections caused by antibiotic-resistant Gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother. 2005;49:760-6.
  • 20. Ballouz T, Aridi J, Afif C, Irani J, Lakis C, Nasreddine R, et al. Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia. Front Cell Infect Microbiol. 2017;7:156.
  • 21. Su G, Xu H, Riggi E, He Z, Lu L, Lindholm B, et al. Association of Kidney Function with Infections by Multidrug-Resistant Organisms: An Electronic Medical Record Analysis. Sci Rep. 2018;8:13372.
  • 22. Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, et al. Bloodstream infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for mortality and treatment outcome, with special emphasis on antimicrobial therapy. Antimicrob Agents Chemother. 2004;48:4574-81.
  • 23. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61-111.
  • 24. Bian X, Liu X, Zhang X, Li X, Zhang J, Zheng H, et al. Epidemiological and genomic characteristics of Acinetobacter baumannii from different infection sites using comparative genomics. BMC Genomics. 2021;22:530.
  • 25. Liu Y, Wang Q, Zhao C, Chen H, Li H, Wang H, et al. Prospective multi-center evaluation on risk factors, clinical characteristics and outcomes due to carbapenem resistance in Acinetobacter baumannii complex bacteraemia: experience from the Chinese Antimicrobial Resistance Surveillance of Nosocomial Infections (CARES) Network. J Med Microbiol. 2020;69:949-59.

Risk Factors for Antibiotic Resistance and Mortality in Nosocomial Gram-negative Bloodstream Infections: A Retrospective Study

Year 2022, Volume: 3 Issue: 2, 123 - 130, 30.04.2022

Abstract

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.

References

  • 1. Abat C, Rolain JM, Dubourg G, Fournier PE, Chaudet H, Raoult D. Evaluating the Clinical Burden and Mortality Attributable to Antibiotic Resistance: The Disparity of Empirical Data and Simple Model Estimations. Clin Infect Dis. 2017;65:S58-63.
  • 2. Wu JN, Gan TE, Zhu YX, Cao JM, Ji CH, Wu YH, et al. Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study. J Zhejiang Univ Sci B. 2015;16:70-7
  • 3. Alp E, Damani N. Healthcare-associated infections in intensive care units: epidemiology and infection control in low-to-middle income countries. J Infect Dev Ctries. 2015;9:1040-5.
  • 4. Lark RL, Chenoweth C, Saint S, Zemencuk JK, Lipsky BA, Plorde JJ. Four year prospective evaluation of nosocomial bacteremia: epidemiology, microbiology, and patient outcome. Diagn Microbiol Infect Dis. 2000;38:131-40.
  • 5. Edmond MB, Wallace SE, McClish DK, Pfaller MA, Jones RN, Wenzel RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis. 1999;29:239-44.
  • 6. Viscoli C. Bloodstream Infections: The peak of the iceberg. Virulence. 2016;7:248-51.
  • 7. Papanikolopoulou A, Maltezou HC, Gargalianos-Kakolyris P, Michou I, Kalofissoudis Y, Moussas N, et al. Central-line-associated bloodstream infections, multi-drug-resistant bacteraemias and infection control interventions: a 6-year time-series analysis in a tertiary care hospital in Greece. J Hosp Infect. 2022;123:27-33.
  • 8. Sadeghi H, Khoei SG, Bakht M, Rostamani M, Rahimi S, Ghaemi M, et al. A retrospective cross-sectional survey on nosocomial bacterial infections and their antimicrobial susceptibility patterns in hospitalized patients in northwest of Iran. BMC Res Notes. 2021;14:88.
  • 9. Lee CR, Cho IH, Jeong BC, Lee SH. Strategies to minimize antibiotic resistance. Int J Environ Res Public Health. 2013;10:4274-305.
  • 10. Blot S, Vandewoude K, De Bacquer D, Colardyn F. Nosocomial bacteremia caused by antibiotic-resistant Gram-negative bacteria in critically ill patients: clinical outcome and length of hospitalization. Clin Infect Dis. 2002;34:1600-6.
  • 11. Woolhouse M, Waugh C, Perry MR, Nair H. Global disease burden due to antibiotic resistance - state of the evidence. J Glob Health. 2016;6:010306.
  • 12. Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis. 2004;39:309-17.
  • 13. Patterson JE, Hardin TC, Kelly CA, Garcia RC, Jorgensen JH. Association of antibiotic utilization measures and control of multiple-drug resistance in Klebsiella pneumoniae. Infect Control Hosp Epidemiol. 2000;21:455-8.
  • 14. Liu W, Guo T, Li H, Zhao Y, Zhang K, Hai Y, et al. Healthcare-associated infection prevention and control management in a tertiary hospital and an overall evaluation. Ann Palliat Med. 2020;9:1536-44.
  • 15. Young J, Badgery-Parker T, Dobbins T, Jorgensen M, Gibbs P, Faragher I, et al. Comparison of ECOG/WHO performance status and ASA score as a measure of functional status. J Pain Symptom Manage. 2015;49:258-64.
  • 16. Girard TD, Ely EW. Bacteremia and sepsis in older adults. Clin Geriatr Med. 2007;23:633-47.
  • 17. Haag-Weber M, Hörl WH. The immune system in uremia and during its treatment. New Horiz. 1995;3:669-79.
  • 18. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813-8.
  • 19. Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, et al. Bloodstream infections caused by antibiotic-resistant Gram-negative bacilli: risk factors for mortality and impact of inappropriate initial antimicrobial therapy on outcome. Antimicrob Agents Chemother. 2005;49:760-6.
  • 20. Ballouz T, Aridi J, Afif C, Irani J, Lakis C, Nasreddine R, et al. Risk Factors, Clinical Presentation, and Outcome of Acinetobacter baumannii Bacteremia. Front Cell Infect Microbiol. 2017;7:156.
  • 21. Su G, Xu H, Riggi E, He Z, Lu L, Lindholm B, et al. Association of Kidney Function with Infections by Multidrug-Resistant Organisms: An Electronic Medical Record Analysis. Sci Rep. 2018;8:13372.
  • 22. Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, et al. Bloodstream infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for mortality and treatment outcome, with special emphasis on antimicrobial therapy. Antimicrob Agents Chemother. 2004;48:4574-81.
  • 23. Kalil AC, Metersky ML, Klompas M, Muscedere J, Sweeney DA, Palmer LB, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63:e61-111.
  • 24. Bian X, Liu X, Zhang X, Li X, Zhang J, Zheng H, et al. Epidemiological and genomic characteristics of Acinetobacter baumannii from different infection sites using comparative genomics. BMC Genomics. 2021;22:530.
  • 25. Liu Y, Wang Q, Zhao C, Chen H, Li H, Wang H, et al. Prospective multi-center evaluation on risk factors, clinical characteristics and outcomes due to carbapenem resistance in Acinetobacter baumannii complex bacteraemia: experience from the Chinese Antimicrobial Resistance Surveillance of Nosocomial Infections (CARES) Network. J Med Microbiol. 2020;69:949-59.
There are 25 citations in total.

Details

Primary Language English
Subjects Biochemistry and Cell Biology (Other), Health Services and Systems (Other)
Journal Section Research Articles
Authors

Tuba Kuruoğlu 0000-0003-3805-367X

Şaban Esen 0000-0002-7947-4692

Publication Date April 30, 2022
Submission Date December 18, 2021
Published in Issue Year 2022 Volume: 3 Issue: 2

Cite

AMA Kuruoğlu T, Esen Ş. Risk Factors for Antibiotic Resistance and Mortality in Nosocomial Gram-negative Bloodstream Infections: A Retrospective Study. JMS. April 2022;3(2):123-130.