Sameer J Patel1, André P Oliveira2, Juyan Julia Zhou2, Luis Alba2, E Yoko Furuya3, Scott A Weisenberg4, Haomiao Jia5, Sarah A Clock2, Christine J Kubin6, Stephen G Jenkins7, Audrey N Schuetz8, Maryam Behta9, Phyllis Della-Latta10, Susan Whittier10, Kyu Rhee11, Lisa Saiman12. 1. Department of Pediatrics, Columbia University Medical Center, New York, NY. Electronic address: sameer.patel@northwestern.edu. 2. Department of Pediatrics, Columbia University Medical Center, New York, NY. 3. Department of Medicine, Columbia University Medical Center, New York, NY; Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, NY. 4. Department of Medicine, Alta Bates Summit Medical Center, Oakland, CA. 5. Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; School of Nursing, Columbia University Medical Center, New York, NY. 6. Department of Medicine, Columbia University Medical Center, New York, NY; Department of Pharmacy, New York-Presbyterian Hospital, New York, NY. 7. Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY. 8. Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY; Clinical Microbiology Laboratory, New York-Presbyterian Hospital, New York, NY. 9. Clinical Performance Improvement, University of Pennsylvania Health System, Philadelphia, PA. 10. Department of Pathology, Columbia University Medical Center, New York, NY. 11. Department of Medicine, Weill Cornell Medical College, New York, NY. 12. Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, NY.
Abstract
BACKGROUND: Extremely drug-resistant gram-negative bacilli (XDR-GNB) increasingly cause health care-associated infections (HAIs) in intensive care units (ICUs). METHODS: A matched case-control (1:2) study was conducted from February 2007 to January 2010 in 16 ICUs. Case and control subjects had HAIs caused by GNB susceptible to ≤1 antibiotic versus ≥2 antibiotics, respectively. Logistic and Cox proportional hazards regression assessed risk factors for HAIs and predictors of mortality, respectively. RESULTS: Overall, 103 case and 195 control subjects were enrolled. An immunocompromised state (odds ratio [OR], 1.55; P = .047) and exposure to amikacin (OR, 13.81; P < .001), levofloxacin (OR, 2.05; P = .005), or trimethoprim-sulfamethoxazole (OR, 3.42; P = .009) were factors associated with XDR-GNB HAIs. Multiple factors in both case and control subjects significantly predicted increased mortality at different time intervals after HAI diagnosis. At 7 days, liver disease (hazard ratio [HR], 5.52), immunocompromised state (HR, 3.41), and bloodstream infection (HR, 2.55) predicted mortality; at 15 days, age (HR, 1.02 per year increase), liver disease (HR, 3.34), and immunocompromised state (HR, 2.03) predicted mortality; and, at 30 days, age (HR, 1.02 per 1-year increase), liver disease (HR, 3.34), immunocompromised state (HR, 2.03), and hospitalization in a medical ICU (HR, 1.85) predicted mortality. CONCLUSION: HAIs caused by XDR-GNB were associated with potentially modifiable factors. Age, liver disease, and immunocompromised state, but not XDR-GNB HAIs, were associated with mortality.
BACKGROUND: Extremely drug-resistant gram-negative bacilli (XDR-GNB) increasingly cause health care-associated infections (HAIs) in intensive care units (ICUs). METHODS: A matched case-control (1:2) study was conducted from February 2007 to January 2010 in 16 ICUs. Case and control subjects had HAIs caused by GNB susceptible to ≤1 antibiotic versus ≥2 antibiotics, respectively. Logistic and Cox proportional hazards regression assessed risk factors for HAIs and predictors of mortality, respectively. RESULTS: Overall, 103 case and 195 control subjects were enrolled. An immunocompromised state (odds ratio [OR], 1.55; P = .047) and exposure to amikacin (OR, 13.81; P < .001), levofloxacin (OR, 2.05; P = .005), or trimethoprim-sulfamethoxazole (OR, 3.42; P = .009) were factors associated with XDR-GNB HAIs. Multiple factors in both case and control subjects significantly predicted increased mortality at different time intervals after HAI diagnosis. At 7 days, liver disease (hazard ratio [HR], 5.52), immunocompromised state (HR, 3.41), and bloodstream infection (HR, 2.55) predicted mortality; at 15 days, age (HR, 1.02 per year increase), liver disease (HR, 3.34), and immunocompromised state (HR, 2.03) predicted mortality; and, at 30 days, age (HR, 1.02 per 1-year increase), liver disease (HR, 3.34), immunocompromised state (HR, 2.03), and hospitalization in a medical ICU (HR, 1.85) predicted mortality. CONCLUSION: HAIs caused by XDR-GNB were associated with potentially modifiable factors. Age, liver disease, and immunocompromised state, but not XDR-GNB HAIs, were associated with mortality.
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