Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels

BMC Infectious Diseases

Jean-Louis Vincent¹  Philippe Vanhems⁹  Sten M Walther⁷  Yasser Sakr³  Jordi Rello^1,10  Marc Leone⁶  Peter Pickkers²  Jeffrey Lipman⁴  Martin Holmbom⁵  Massimo Antonelli⁸  Håkan Hanberger⁵ 

[1] Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium;Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands;Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany;Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, The University of Queensland, Herston, QLD, Australia;Division of Infectious Diseases, Institution of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden;Department of Intensive Care and Anesthesiology, Hôpital Nord, AP-HM Unité de Recherche en Maladies Infectieuses et Transmissibles (URMITE), Aix-Marseille University, Marseilles, France;Division of Cardiovascular Medicine, Department of Medicine and Health, Faculty of Health Sciences, Linköping University, Linköping, Sweden;Università Cattolica del Sacro Cuore - Policlinico Universitario A. Gemelli, Rome, Italy;Service d’Hygiène, Epidémiologie et Prévention, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Université Lyon 1, Lyon, France;Critical Care Department, Vall d'Hebron University Hospital, CIBERES, VHIR, Universitat Autonoma de Barcelona, Barcelona, Spain

关键词: Resistance;    Antibiotic;    Critically ill;    Infection;   

Others  :  1125521
DOI  :  10.1186/1471-2334-14-513

 received in 2014-07-03, accepted in 2014-09-11,  发布年份 2014

【 摘 要 】

Background

Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.

Methods

Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of < 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).

Results

On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P < 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P < 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P < 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.

Conclusions

Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome.

【 授权许可】

   
2014 Hanberger et al.; licensee BioMed Central Ltd.

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