1887

Journal of Medical Microbiology logo

Volume 66, Issue 8

Risk factors and predictors of carbapenem-resistant and mortality in critically ill bacteraemic patients over a 6-year period (2010–15): antibiotics do matter Free

Abstract

and provoke serious infections, especially in intensive care unit (ICU) patients.

The risk factors and predictors of mortality for (=84; 46 carbapenem-resistant) and (=129; all carbapenem-resistant) bloodstream infections (BSIs) in an ICU were evaluated. Antibiotic susceptibility testing was performed using the agar disk diffusion method according to EUCAST guidelines. The minimum inhibitory concentration was determined by a gradient method (Etest). Multilocus sequence typing (MLST) was performed for during the carbapenem-resistant outbreak in 2014. Epidemiological data were collected from the patients’ chart reviews.

Hospitalization during the summer months, prior KPC-producing (KPC-Kp) BSI, and the administration of tigecycline, aminoglycosides and cortisone were independently associated with BSIs. MLST revealed the dissemination of clone ST227, including carbapenem-resistant strains. Hospitalization during the summer months, prior KPC-Kp BSI, and the administration of antibiotics, carbapenem and cortisone were independently associated with BSIs. The 30-day mortality rate for and BSI was 45.2 and 39.5 %, respectively. Sequential organ failure assessment (SOFA) score at onset, septic shock, age, and prior KPC-Kp BSI were significantly associated with BSI mortality. The administration of at least one active antibiotic was identified as a predictor of a good prognosis. Septic shock and simplified acute physiology score (SAPS) II at onset were independently associated with BSI mortality. The administration of at least one active antibiotic and colistin–vancomycin co-administration were identified as predictors of a good prognosis.

KPC-Kp infection predisposes ICU patients to BSI by either or . The administration of at least one active antibiotic leads to better survival rates.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): bloodstream infection , carbapenem resistance , colistin-vancomycin co-administration , intensive care unit (ICU) , seasonality and tigecycline
© 2017 The Authors
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.000538
2017-08-01
2024-04-19
Loading full text...

Full text loading...

/deliver/fulltext/jmm/66/8/1092.html?itemId=/content/journal/jmm/10.1099/jmm.0.000538&mimeType=html&fmt=ahah

References

  1. Garrouste-Orgeas M, Timsit JF, Tafflet M, Misset B, Zahar JR et al. Excess risk of death from intensive care unit-acquired nosocomial bloodstream infections: a reappraisal. Clin Infect Dis 2006; 42:1118–1126 [View Article][PubMed]
     [Google Scholar]
  2. Vincent JL, Rello J, Marshall J, Silva E, Anzueto A et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009; 302:2323–2429 [View Article][PubMed]
     [Google Scholar]
  3. Papadimitriou-Olivgeris M, Marangos M, Christofidou M, Fligou F, Bartzavali C et al. Risk factors for infection and predictors of mortality among patients with KPC-producing Klebsiella pneumoniae bloodstream infections in the intensive care unit. Scand J Infect Dis 2014; 46:642–648 [View Article][PubMed]
     [Google Scholar]
  4. Michalopoulos A, Falagas ME, Karatza DC, Alexandropoulou P, Papadakis E et al. Epidemiologic, clinical characteristics, and risk factors for adverse outcome in multiresistant Gram-negative primary bacteremia of critically ill patients. Am J Infect Control 2011; 39:396–400 [View Article][PubMed]
     [Google Scholar]
  5. Potron A, Poirel L, Nordmann P. Emerging broad-spectrum resistance in Pseudomonas aeruginosa and Acinetobacter baumannii: mechanisms and epidemiology. Int J Antimicrob Agents 2015; 45:568–585 [View Article][PubMed]
     [Google Scholar]
  6. Koutsogiannou M, Drougka E, Liakopoulos A, Jelastopulu E, Petinaki E et al. Spread of multidrug-resistant Pseudomonas aeruginosa clones in a university hospital. J Clin Microbiol 2013; 51:665–668 [View Article][PubMed]
     [Google Scholar]
  7. Liakopoulos A, Mavroidi A, Katsifas EA, Theodosiou A, Karagouni AD et al. Carbapenemase-producing Pseudomonas aeruginosa from central Greece: molecular epidemiology and genetic analysis of class I integrons. BMC Infect Dis 2013; 13:505 [View Article][PubMed]
     [Google Scholar]
  8. Ceccarelli G, Oliva A, D'Ettorre G, D'Abramo A, Caresta E et al. The role of vancomycin in addition with colistin and meropenem against colistin-sensitive multidrug resistant Acinetobacter baumannii causing severe infections in a Paediatric Intensive Care Unit. BMC Infect Dis 2015; 15:393 [View Article][PubMed]
     [Google Scholar]
  9. Garnacho-Montero J, Amaya-Villar R, Gutiérrez-Pizarraya A, Espejo-Gutiérrez de Tena E, Artero-González ML et al. Clinical efficacy and safety of the combination of colistin plus vancomycin for the treatment of severe infections caused by carbapenem-resistant Acinetobacter baumannii. Chemotherapy 2013; 59:225–231 [View Article][PubMed]
     [Google Scholar]
  10. Gordon NC, Png K, Wareham DW. Potent synergy and sustained bactericidal activity of a vancomycin-colistin combination versus multidrug-resistant strains of Acinetobacter baumannii. Antimicrob Agents Chemother 2010; 54:5316–5322 [View Article][PubMed]
     [Google Scholar]
  11. Yang H, Lv N, Hu L, Liu Y, Cheng J et al. In vivo activity of vancomycin combined with colistin against multidrug-resistant strains of Acinetobacter baumannii in a Galleria mellonella model. Infect Dis 2016; 48:189–194 [View Article]
     [Google Scholar]
  12. European Committee on Antimicrobial Susceptibility Testing (EUCAST) 2015; Breakpoint tables for interpretation of MICs and zone diameters. Version 5.0. EUCAST. Available online at www.eucast.org
  13. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36:309–332 [View Article][PubMed]
     [Google Scholar]
  14. Safdar N, Maki DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, Gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002; 136:834–844 [View Article][PubMed]
     [Google Scholar]
  15. Delano MJ, Thayer T, Gabrilovich S, Kelly-Scumpia KM, Winfield RD et al. Sepsis induces early alterations in innate immunity that impact mortality to secondary infection. J Immunol 2011; 186:195–202 [View Article][PubMed]
     [Google Scholar]
  16. Tumbarello M, Repetto E, Trecarichi EM, Bernardini C, de Pascale G et al. Multidrug-resistant Pseudomonas aeruginosa bloodstream infections: risk factors and mortality. Epidemiol Infect 2011; 139:1740–1749 [View Article][PubMed]
     [Google Scholar]
  17. Berg RD. Bacterial translocation from the gastrointestinal tract. Adv Exp Med Biol 1999; 473:11–30[PubMed] [CrossRef]
     [Google Scholar]
  18. Hsu CR, Pan YJ, Liu JY, Chen CT, Lin TL et al. Klebsiella pneumoniae translocates across the intestinal epithelium via Rho GTPase- and phosphatidylinositol 3-kinase/Akt-dependent cell invasion. Infect Immun 2015; 83:769–779 [View Article][PubMed]
     [Google Scholar]
  19. De Rosa FG, Corcione S, Pagani N, Di Perri G. From ESKAPE to ESCAPE, from KPC to CCC. Clin Infect Dis 2015; 60:1289–1290 [View Article][PubMed]
     [Google Scholar]
  20. Papadimitriou-Olivgeris M, Spiliopoulou A, Fligou F, Manolopoulou P, Spiliopoulou I et al. Association of KPC-producing Klebsiella pneumoniae colonization or infection with Candida isolation and selection of non-albicans species. Diagn Microbiol Infect Dis 2014; 80:227–232 [View Article][PubMed]
     [Google Scholar]
  21. Chusri S, Silpapojakul K, McNeil E, Singkhamanan K, Chongsuvivatwong V. Impact of antibiotic exposure on occurrence of nosocomial carbapenem-resistant Acinetobacter baumannii infection: a case control study. J Infect Chemother 2015; 21:90–95 [View Article][PubMed]
     [Google Scholar]
  22. Tuon FF, Gortz LW, Rocha JL. Risk factors for pan-resistant Pseudomonas aeruginosa bacteremia and the adequacy of antibiotic therapy. Braz J Infect Dis 2012; 16:351–356 [View Article][PubMed]
     [Google Scholar]
  23. Kim YJ, Kim SI, Hong KW, Kim YR, Park YJ et al. Risk factors for mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia: impact of appropriate antimicrobial therapy. J Korean Med Sci 2012; 27:471–475 [View Article][PubMed]
     [Google Scholar]
  24. Richet H. Seasonality in Gram-negative and healthcare-associated infections. Clin Microbiol Infect 2012; 18:934–940 [View Article][PubMed]
     [Google Scholar]
  25. Eber MR, Shardell M, Schweizer ML, Laxminarayan R, Perencevich EN. Seasonal and temperature-associated increases in Gram-negative bacterial bloodstream infections among hospitalized patients. PLoS One 2011; 6:e25298 [View Article][PubMed]
     [Google Scholar]
  26. Schwab F, Gastmeier P, Meyer E. The warmer the weather, the more Gram-negative bacteria - impact of temperature on clinical isolates in intensive care units. PLoS One 2014; 9:e91105 [View Article][PubMed]
     [Google Scholar]
  27. Castanheira M, Deshpande LM, Costello A, Davies TA, Jones RN. Epidemiology and carbapenem resistance mechanisms of carbapenem-non-susceptible Pseudomonas aeruginosa collected during 2009-11 in 14 European and Mediterranean countries. J Antimicrob Chemother 2014; 69:1804–1814 [View Article][PubMed]
     [Google Scholar]
  28. Breedt J, Teras J, Gardovskis J, Maritz FJ, Vaasna T et al. Safety and efficacy of tigecycline in treatment of skin and skin structure infections: results of a double-blind phase 3 comparison study with vancomycin-aztreonam. Antimicrob Agents Chemother 2005; 49:4658–4666 [View Article][PubMed]
     [Google Scholar]
  29. Oliva ME, Rekha A, Yellin A, Pasternak J, Campos M et al. A multicenter trial of the efficacy and safety of tigecycline versus imipenem/cilastatin in patients with complicated intra-abdominal infections [Study ID Numbers: 3074A1-301-WW; ClinicalTrials.gov Identifier: NCT00081744]. BMC Infect Dis 2005; 5:88 [View Article][PubMed]
     [Google Scholar]
  30. García-Cabrera E, Jiménez-Mejías ME, Gil Navarro MV, Gómez-Gómez MJ, Ortiz-Leyba C et al. Superinfection during treatment of nosocomial infections with tigecycline. Eur J Clin Microbiol Infect Dis 2010; 29:867–871 [View Article][PubMed]
     [Google Scholar]
  31. Ulu-Kilic A, Alp E, Altun D, Cevahir F, Kalın G et al. Increasing frequency of Pseudomonas aeruginosa infections during tigecycline use. J Infect Dev Ctries 2015; 9:309–312 [View Article][PubMed]
     [Google Scholar]
  32. Chen SJ, Chao TF, Chiang MC, Kuo SC, Chen LY et al. Predictors of mortality in surgical patients with Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect 2011; 44:209–214 [View Article][PubMed]
     [Google Scholar]
  33. Liu CP, Shih SC, Wang NY, Wu AY, Sun FJ et al. Risk factors of mortality in patients with carbapenem-resistant Acinetobacter baumannii bacteremia. J Microbiol Immunol Infect 2016; 49:934–940 [View Article][PubMed]
     [Google Scholar]
  34. Tan SH, Teng CB, Ng TM, Lye DC. Antibiotic therapy and clinical outcomes of Pseudomonas aeruginosa (PA) bacteraemia. Ann Acad Med Singapore 2014; 43:526–534[PubMed]
     [Google Scholar]
  35. Esterly JS, Griffith M, Qi C, Malczynski M, Postelnick MJ et al. Impact of carbapenem resistance and receipt of active antimicrobial therapy on clinical outcomes of Acinetobacter baumannii bloodstream infections. Antimicrob Agents Chemother 2011; 55:4844–4849 [View Article][PubMed]
     [Google Scholar]
  36. Vitkauskienė A, Skrodenienė E, Dambrauskienė A, Macas A, Sakalauskas R. Pseudomonas aeruginosa bacteremia: resistance to antibiotics, risk factors, and patient mortality. Medicina 2010; 46:490–495[PubMed]
     [Google Scholar]
  37. Zhang Y, Chen XL, Huang AW, Liu SL, Liu WJ et al. Mortality attributable to carbapenem-resistant Pseudomonas aeruginosa bacteremia: a meta-analysis of cohort studies. Emerg Microbes Infect 2016; 5:e27 [View Article][PubMed]
     [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.000538
Loading
Risk factors and predictors of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii mortality in critically ill bacteraemic patients over a 6-year period (2010–15): antibiotics do matter
J. Med. Microbiol. 66, 1092 (2017); https://doi.org/10.1099/jmm.0.000538
/content/journal/jmm/10.1099/jmm.0.000538
/content/journal/jmm/10.1099/jmm.0.000538
Loading

Data & Media loading...

Most cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error