V Bonnet1, H Dupont2, S Glorion3, M Aupée3, E Kipnis4, J L Gérard5, J L Hanouz5, M O Fischer6. 1. Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France. 2. Anaesthesiology and Critical Care Department, Amiens University Medical Center, Amiens, France; INSERM U 1088, University of Picardie Jules Verne, Centre Universitaire de Recherche en Santé, Amiens, France. 3. Regional Coordinating Centre for Healthcare-Associated Infections Control (CClin Ouest), Rennes, France. 4. Department of Anaesthesiology and Critical Care - CHU Lille, Lille, France; Host-Pathogen Translational Research, EA 7366, University of Lille, Lille, France. 5. Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France; Normandie Université, Esplanade de la Paix, CS 14 032, Caen, France. 6. Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France; Normandie Université, Esplanade de la Paix, CS 14 032, Caen, France. Electronic address: fischer-mo@chu-caen.fr.
Abstract
BACKGROUND: Bacterial resistance to antibiotics is a daily concern in intensive care units. However, few data are available concerning the clinical consequences of in-vitro-defined resistance. AIM: To compare the mortality of patients with nosocomial infections according to bacterial resistance profiles. METHODS: The prospective surveillance registry in 29 French intensive care units (ICUs) participating during the years 2000-2013 was retrospectively analysed. All patients presenting with a nosocomial infection in ICU were included. FINDINGS: The registry contained 88,000 eligible patients, including 10,001 patients with a nosocomial infection. Among them, 3092 (36.7%) were related to resistant micro-organisms. Gram-negative bacilli exhibited the highest rate of resistance compared to Gram-positive cocci (52.8% vs 48.1%; P < 0.001). In-hospital mortality was higher in cases of patients with antibiotic-resistant infectious agents (51.9% vs 45.5%; P < 0.001), and critical care length of stay was longer (33 ± 26 vs 29 ± 22 days; P < 0.001). These results remained significant after SAPS II matching (P < 0.001) and in the Gram-negative bacilli and Gram-positive cocci subgroups. No difference in mortality was found with respect to origin prior to admission. CONCLUSION: Patients with bacterial resistance had higher ICU mortality and increased length of stay, regardless of the bacterial species or origin of the patient.
BACKGROUND: Bacterial resistance to antibiotics is a daily concern in intensive care units. However, few data are available concerning the clinical consequences of in-vitro-defined resistance. AIM: To compare the mortality of patients with nosocomial infections according to bacterial resistance profiles. METHODS: The prospective surveillance registry in 29 French intensive care units (ICUs) participating during the years 2000-2013 was retrospectively analysed. All patients presenting with a nosocomial infection in ICU were included. FINDINGS: The registry contained 88,000 eligible patients, including 10,001 patients with a nosocomial infection. Among them, 3092 (36.7%) were related to resistant micro-organisms. Gram-negative bacilli exhibited the highest rate of resistance compared to Gram-positive cocci (52.8% vs 48.1%; P < 0.001). In-hospital mortality was higher in cases of patients with antibiotic-resistant infectious agents (51.9% vs 45.5%; P < 0.001), and critical care length of stay was longer (33 ± 26 vs 29 ± 22 days; P < 0.001). These results remained significant after SAPS II matching (P < 0.001) and in the Gram-negative bacilli and Gram-positive cocci subgroups. No difference in mortality was found with respect to origin prior to admission. CONCLUSION:Patients with bacterial resistance had higher ICU mortality and increased length of stay, regardless of the bacterial species or origin of the patient.
Authors: Miquel Serra-Burriel; Matthew Keys; Carlos Campillo-Artero; Antonella Agodi; Martina Barchitta; Achilleas Gikas; Carlos Palos; Guillem López-Casasnovas Journal: PLoS One Date: 2020-01-10 Impact factor: 3.240