Sameer S Kadri1, Jeffrey R Strich2, Bruce J Swihart3, Samuel Hohmann4, John P Dekker5, Tara Palmore6, Stephanie Bonne7, Bradley Freeman8, Jillian Raybould9, Nirav G Shah10, Devang Patel11, Jennifer Husson11, Mitchell D Jacobs12, Lan Duong13, Dean Follmann3, David C Hooper14, Joseph Timpone15, Robert L Danner16. 1. Critical Care Medicine Department, Clinical Center-National Institutes of Health, Bethesda, MD; Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA. Electronic address: drskadri@gmail.com. 2. Critical Care Medicine Department, Clinical Center-National Institutes of Health, Bethesda, MD; Department of Medicine, Georgetown University Hospital, Washington, DC. 3. Biostatistics Research Branch, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD. 4. Vizient, Inc., Chicago, IL; Health Systems Management, Rush University, Chicago, IL. 5. Department of Laboratory Medicine, Clinical Center-National Institutes of Health, Bethesda, MD. 6. Hospital Epidemiology Service, Clinical Center-National Institutes of Health, Bethesda, MD. 7. Division of Trauma and Critical Care, Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ. 8. Department of Surgery, Washington University School of Medicine, St. Louis, MO. 9. Division of Infectious Diseases, Virginia Commonwealth University Medical Center, Richmond, VA; Division of Infectious Diseases and Travel Medicine, Georgetown University Hospital, Washington, DC. 10. Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, MD. 11. Division of Infectious Diseases, University of Maryland, Baltimore, MD. 12. Department of Medicine, University of Maryland, Baltimore, MD; Division of Pulmonary and Critical Care, Thomas Jefferson University Hospital, Philadelphia, PA. 13. Department of Pharmacy, Georgetown University Hospital, Washington, DC. 14. Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA. 15. Division of Infectious Diseases, Virginia Commonwealth University Medical Center, Richmond, VA. 16. Critical Care Medicine Department, Clinical Center-National Institutes of Health, Bethesda, MD.
Abstract
BACKGROUND: Tracer antibiotic algorithms using administrative data were investigated to estimate mortality attributable to extensively drug-resistant gram-negative infections (GNIs). METHODS: Among adult inpatients coded for GNIs, colistin cases and 2 comparator cohorts (non-carbapenem β-lactams or carbapenems) treated for ≥4 consecutive days, or died while receiving the antibiotic, were separately propensity score-matched (1:2). Attributable mortality was the in-hospital mortality difference among propensity-matched groups. Infection characteristics and sepsis severity influences on attributable mortality were examined. Algorithm accuracy was assessed by chart review. RESULTS: Of 232,834 GNIs between 2010 and 2013 at 79 hospitals, 1,023 per 3,350 (30.5%) colistin and 9,188 per 105,641 (8.7%) β-lactam (non-carbapenem) comparator cases died. Propensity-matched colistin and β-lactam case mortality was 29.2% and 16.6%, respectively, for an attributable mortality of 12.6% (95% confidence interval 10.8-14.4%). Attributable mortality varied from 11.0% (7.5%-14.7%) for urinary to 15.5% (12.6%-18.4%) for respiratory (P < .0001), and 4.6% (2.1%-7.4%) for early (≤4 days) to 16.6% (14.3%-18.9%) for late-onset infections (P < .0001). Attributable mortality decreased to 7.5% (5.6%-9.4%) using a carbapenem comparator cohort but increased 9-fold in patients coded for severe sepsis or septic shock (P < .0001). Our colistin algorithm had a positive predictive value of 60.4% and sensitivity of 65.3%. CONCLUSIONS: Mortality attributable to treatment-limiting resistance during GNIs varied considerably by site, onset, and severity of infection. Published by Elsevier Inc.
BACKGROUND: Tracer antibiotic algorithms using administrative data were investigated to estimate mortality attributable to extensively drug-resistant gram-negative infections (GNIs). METHODS: Among adult inpatients coded for GNIs, colistin cases and 2 comparator cohorts (non-carbapenem β-lactams or carbapenems) treated for ≥4 consecutive days, or died while receiving the antibiotic, were separately propensity score-matched (1:2). Attributable mortality was the in-hospital mortality difference among propensity-matched groups. Infection characteristics and sepsis severity influences on attributable mortality were examined. Algorithm accuracy was assessed by chart review. RESULTS: Of 232,834 GNIs between 2010 and 2013 at 79 hospitals, 1,023 per 3,350 (30.5%) colistin and 9,188 per 105,641 (8.7%) β-lactam (non-carbapenem) comparator cases died. Propensity-matched colistin and β-lactam case mortality was 29.2% and 16.6%, respectively, for an attributable mortality of 12.6% (95% confidence interval 10.8-14.4%). Attributable mortality varied from 11.0% (7.5%-14.7%) for urinary to 15.5% (12.6%-18.4%) for respiratory (P < .0001), and 4.6% (2.1%-7.4%) for early (≤4 days) to 16.6% (14.3%-18.9%) for late-onset infections (P < .0001). Attributable mortality decreased to 7.5% (5.6%-9.4%) using a carbapenem comparator cohort but increased 9-fold in patients coded for severe sepsis or septic shock (P < .0001). Our colistin algorithm had a positive predictive value of 60.4% and sensitivity of 65.3%. CONCLUSIONS:Mortality attributable to treatment-limiting resistance during GNIs varied considerably by site, onset, and severity of infection. Published by Elsevier Inc.
Entities:
Keywords:
Big data; Clinical impact; Colistin; Cost; Outcomes; Pharmacoepidemiology
Authors: Peter Q Eichacker; Eric P Gerstenberger; Steven M Banks; Xizhong Cui; Charles Natanson Journal: Am J Respir Crit Care Med Date: 2002-08-28 Impact factor: 21.405
Authors: A-P Magiorakos; A Srinivasan; R B Carey; Y Carmeli; M E Falagas; C G Giske; S Harbarth; J F Hindler; G Kahlmeter; B Olsson-Liljequist; D L Paterson; L B Rice; J Stelling; M J Struelens; A Vatopoulos; J T Weber; D L Monnet Journal: Clin Microbiol Infect Date: 2011-07-27 Impact factor: 8.067
Authors: D Ben-David; R Kordevani; N Keller; I Tal; A Marzel; O Gal-Mor; Y Maor; G Rahav Journal: Clin Microbiol Infect Date: 2011-07-01 Impact factor: 8.067
Authors: Sameer S Kadri; Jennifer Adjemian; Yi Ling Lai; Alicen B Spaulding; Emily Ricotta; D Rebecca Prevots; Tara N Palmore; Chanu Rhee; Michael Klompas; John P Dekker; John H Powers; Anthony F Suffredini; David C Hooper; Scott Fridkin; Robert L Danner Journal: Clin Infect Dis Date: 2018-11-28 Impact factor: 9.079
Authors: Rebecca R Roberts; Bala Hota; Ibrar Ahmad; R Douglas Scott; Susan D Foster; Fauzia Abbasi; Shari Schabowski; Linda M Kampe; Ginevra G Ciavarella; Mark Supino; Jeremy Naples; Ralph Cordell; Stuart B Levy; Robert A Weinstein Journal: Clin Infect Dis Date: 2009-10-15 Impact factor: 9.079
Authors: Gopi Patel; Shirish Huprikar; Stephanie H Factor; Stephen G Jenkins; David P Calfee Journal: Infect Control Hosp Epidemiol Date: 2008-12 Impact factor: 3.254
Authors: Jeffrey R Strich; Emily Ricotta; Sarah Warner; Yi Ling Lai; Cumhur Y Demirkale; Samuel F Hohmann; Chanu Rhee; Michael Klompas; Tara Palmore; John H Powers; John P Dekker; Jennifer Adjemian; Roland Matsouaka; Christopher W Woods; Robert L Danner; Sameer S Kadri Journal: Clin Infect Dis Date: 2021-02-16 Impact factor: 9.079
Authors: Jeffrey R Strich; Sarah Warner; Yi Ling Lai; Cumhur Y Demirkale; John H Powers; Robert L Danner; Sameer S Kadri Journal: Lancet Infect Dis Date: 2020-06-04 Impact factor: 71.421