Carbapenem resistance, inappropriate empiric treatment and outcomes among patients hospitalized with Enterobacteriaceae urinary tract infection, pneumonia and sepsis

BMC Infectious Diseases

Research Article

Marya D. Zilberberg¹  Brian H. Nathanson²  Weihong Fan³  Kate Sulham³  Andrew F. Shorr⁴ 

[1] EviMed Research Group, LLC, PO Box 303, 01032, Goshen, MA, USA;OptiStatim, LLC, PO Box 60844, 01116, Longmeadow, MA, USA;The Medicines Company, 8 Sylvan Way, 07054, Parsippany, NJ, USA;Washington Hospital Center, 110 Irving St. NW, 20010, Washington, DC, USA;

关键词: UTI;    Pneumonia;    Sepsis;    Enterobacteriaceae;    Antimicrobial resistance;    Inappropriate empiric therapy;    Hospital mortality;    Hospital cost;   

DOI  :  10.1186/s12879-017-2383-z

 received in 2016-11-17, accepted in 2017-04-05,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundDrug 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.MethodsWe 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.ResultsAmong 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 3× 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.ConclusionsIn 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.

【 授权许可】

CC BY   
© The Author(s). 2017