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Are infections due to resistant pathogens associated with a worse outcome in critically ill patients?
Objectives. To evaluate the outcome of critically ill patients infected with antimicrobial resistant microorganisms, and to analyse the factors involved in the development of antimicrobial resistance. Methods. All patients admitted to a 31-bed mixed medico-surgical intensive care unit who developed...
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| Published in: | The Journal of infection 2003-11, Vol.47 (4), p.307-316 |
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| creator | Peres-Bota, Daliana Rodriguez, Hector Dimopoulos, George DaRos, Alessandra Mélot, Christian Struelens, Marc J Vincent, Jean-Louis |
| description | Objectives. To evaluate the outcome of critically ill patients infected with antimicrobial resistant microorganisms, and to analyse the factors involved in the development of antimicrobial resistance.
Methods. All patients admitted to a 31-bed mixed medico-surgical intensive care unit who developed a nosocomial infection were prospectively followed until discharge or death.
Results. Of 949 consecutive patients admitted, 186 developed a nosocomial infection: 79 with an antimicrobial-resistant pathogen and 107 with susceptible strains. The lungs were the main source of infections in both groups. The main resistant microorganisms were
Enterobacter aerogenes, methicillin resistant
Staphylococcus aureus (MRSA), and
Enterobacter cloacae. The main susceptible microorganisms were
Enterobacter spp., methicillin susceptible
S. aureus (MSSA), and
Proteus mirabilis. Patients infected with resistant strains had a longer length of stay prior to infection (9±4 vs. 5±3 days), longer total length of stay (18±16 vs. 11±7 days), longer duration of mechanical ventilation (12±15 vs. 6±7 days), and more severe coagulation, liver, and renal dysfunction (all
p |
| doi_str_mv | 10.1016/S0163-4453(03)00100-2 |
| format | article |
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Methods. All patients admitted to a 31-bed mixed medico-surgical intensive care unit who developed a nosocomial infection were prospectively followed until discharge or death.
Results. Of 949 consecutive patients admitted, 186 developed a nosocomial infection: 79 with an antimicrobial-resistant pathogen and 107 with susceptible strains. The lungs were the main source of infections in both groups. The main resistant microorganisms were
Enterobacter aerogenes, methicillin resistant
Staphylococcus aureus (MRSA), and
Enterobacter cloacae. The main susceptible microorganisms were
Enterobacter spp., methicillin susceptible
S. aureus (MSSA), and
Proteus mirabilis. Patients infected with resistant strains had a longer length of stay prior to infection (9±4 vs. 5±3 days), longer total length of stay (18±16 vs. 11±7 days), longer duration of mechanical ventilation (12±15 vs. 6±7 days), and more severe coagulation, liver, and renal dysfunction (all
p<0.05). The maximum degrees of organ failure during the ICU stay, and the respiratory dysfunction, but not infection with a resistant pathogen, were independent predictors for death. Multivariate logistic regression revealed previous use of multiple antibiotics, duration of length of stay prior to infection, and the degree of liver failure as independent factors for development of infection with resistant organisms.
Conclusions. Infection with antimicrobial resistant microorganisms is not an independent predictor for death. The development of antimicrobial resistance is related to the previous use of multiple antibiotics, the ICU length of stay, and the severity of hepatic dysfunction.</description><identifier>ISSN: 0163-4453</identifier><identifier>EISSN: 1532-2742</identifier><identifier>DOI: 10.1016/S0163-4453(03)00100-2</identifier><identifier>PMID: 14556755</identifier><identifier>CODEN: JINFD2</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Antibiotic resistance ; Biological and medical sciences ; Chi-Square Distribution ; Critical Illness ; Cross Infection - drug therapy ; Cross Infection - epidemiology ; Cross Infection - microbiology ; Drug Resistance ; Enterobacter aerogenes ; Enterobacter cloacae ; Female ; Fundamental and applied biological sciences. Psychology ; General aspects ; Humans ; Infection ; Intensive Care Units ; Logistic Models ; Male ; Medical sciences ; Microbial Sensitivity Tests ; Microbiology ; Middle Aged ; Outcome ; Prognosis ; Prospective Studies ; Proteus mirabilis ; Resistant pathogens ; Risk Factors ; Staphylococcus aureus ; Susceptible pathogens ; Virology</subject><ispartof>The Journal of infection, 2003-11, Vol.47 (4), p.307-316</ispartof><rights>2003 The British Infection Society</rights><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c422t-a1611c405e3a652e354610a0e4a8614d86a73c279501e9b89f0f4c19a1a028323</citedby><cites>FETCH-LOGICAL-c422t-a1611c405e3a652e354610a0e4a8614d86a73c279501e9b89f0f4c19a1a028323</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15210530$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/14556755$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Peres-Bota, Daliana</creatorcontrib><creatorcontrib>Rodriguez, Hector</creatorcontrib><creatorcontrib>Dimopoulos, George</creatorcontrib><creatorcontrib>DaRos, Alessandra</creatorcontrib><creatorcontrib>Mélot, Christian</creatorcontrib><creatorcontrib>Struelens, Marc J</creatorcontrib><creatorcontrib>Vincent, Jean-Louis</creatorcontrib><title>Are infections due to resistant pathogens associated with a worse outcome in critically ill patients?</title><title>The Journal of infection</title><addtitle>J Infect</addtitle><description>Objectives. To evaluate the outcome of critically ill patients infected with antimicrobial resistant microorganisms, and to analyse the factors involved in the development of antimicrobial resistance.
Methods. All patients admitted to a 31-bed mixed medico-surgical intensive care unit who developed a nosocomial infection were prospectively followed until discharge or death.
Results. Of 949 consecutive patients admitted, 186 developed a nosocomial infection: 79 with an antimicrobial-resistant pathogen and 107 with susceptible strains. The lungs were the main source of infections in both groups. The main resistant microorganisms were
Enterobacter aerogenes, methicillin resistant
Staphylococcus aureus (MRSA), and
Enterobacter cloacae. The main susceptible microorganisms were
Enterobacter spp., methicillin susceptible
S. aureus (MSSA), and
Proteus mirabilis. Patients infected with resistant strains had a longer length of stay prior to infection (9±4 vs. 5±3 days), longer total length of stay (18±16 vs. 11±7 days), longer duration of mechanical ventilation (12±15 vs. 6±7 days), and more severe coagulation, liver, and renal dysfunction (all
p<0.05). The maximum degrees of organ failure during the ICU stay, and the respiratory dysfunction, but not infection with a resistant pathogen, were independent predictors for death. Multivariate logistic regression revealed previous use of multiple antibiotics, duration of length of stay prior to infection, and the degree of liver failure as independent factors for development of infection with resistant organisms.
Conclusions. Infection with antimicrobial resistant microorganisms is not an independent predictor for death. The development of antimicrobial resistance is related to the previous use of multiple antibiotics, the ICU length of stay, and the severity of hepatic dysfunction.</description><subject>Antibiotic resistance</subject><subject>Biological and medical sciences</subject><subject>Chi-Square Distribution</subject><subject>Critical Illness</subject><subject>Cross Infection - drug therapy</subject><subject>Cross Infection - epidemiology</subject><subject>Cross Infection - microbiology</subject><subject>Drug Resistance</subject><subject>Enterobacter aerogenes</subject><subject>Enterobacter cloacae</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>General aspects</subject><subject>Humans</subject><subject>Infection</subject><subject>Intensive Care Units</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Microbial Sensitivity Tests</subject><subject>Microbiology</subject><subject>Middle Aged</subject><subject>Outcome</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Proteus mirabilis</subject><subject>Resistant pathogens</subject><subject>Risk Factors</subject><subject>Staphylococcus aureus</subject><subject>Susceptible pathogens</subject><subject>Virology</subject><issn>0163-4453</issn><issn>1532-2742</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><recordid>eNqFkU9v1DAQxS0EokvhI4B8AcEhZfw3yamqKqCVKnEonK2pM6FG2XixnVb99jjsih4rjTwH_2bm6T3G3go4ESDs5-v6qEZroz6C-gQgABr5jG2EUbKRrZbP2eY_csRe5fwbAHrV25fsSGhjbGvMhtFZIh7mkXwJcc58WIiXyBPlkAvOhe-w3MZfVL8w5-gDFhr4fSi3HPl9TJl4XIqP23UL9ymU4HGaHniYpnU20Fzy6Wv2YsQp05tDP2Y_v375cX7RXH3_dnl-dtV4LWVpUFghvAZDCq2RpIy2AhBIY2eFHjqLrfKy7Q0I6m-6foRRe9GjQJCdkuqYfdjv3aX4Z6Fc3DZkT9OEM8Ulu1ZIa2wPT4Ki643RxlbQ7EGfYs6JRrdLYYvpwQlwaxDuXxBuddlBrTUItyp5dziw3GxpeJw6OF-B9wcAc3VsTDj7kB85IwUYtSo93XNUfbsLlFz21VRPQ0g1NDfE8ISUv8C-pCA</recordid><startdate>20031101</startdate><enddate>20031101</enddate><creator>Peres-Bota, Daliana</creator><creator>Rodriguez, Hector</creator><creator>Dimopoulos, George</creator><creator>DaRos, Alessandra</creator><creator>Mélot, Christian</creator><creator>Struelens, Marc J</creator><creator>Vincent, Jean-Louis</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>C1K</scope><scope>7X8</scope></search><sort><creationdate>20031101</creationdate><title>Are infections due to resistant pathogens associated with a worse outcome in critically ill patients?</title><author>Peres-Bota, Daliana ; Rodriguez, Hector ; Dimopoulos, George ; DaRos, Alessandra ; Mélot, Christian ; Struelens, Marc J ; Vincent, Jean-Louis</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c422t-a1611c405e3a652e354610a0e4a8614d86a73c279501e9b89f0f4c19a1a028323</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Antibiotic resistance</topic><topic>Biological and medical sciences</topic><topic>Chi-Square Distribution</topic><topic>Critical Illness</topic><topic>Cross Infection - drug therapy</topic><topic>Cross Infection - epidemiology</topic><topic>Cross Infection - microbiology</topic><topic>Drug Resistance</topic><topic>Enterobacter aerogenes</topic><topic>Enterobacter cloacae</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>General aspects</topic><topic>Humans</topic><topic>Infection</topic><topic>Intensive Care Units</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Microbial Sensitivity Tests</topic><topic>Microbiology</topic><topic>Middle Aged</topic><topic>Outcome</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Proteus mirabilis</topic><topic>Resistant pathogens</topic><topic>Risk Factors</topic><topic>Staphylococcus aureus</topic><topic>Susceptible pathogens</topic><topic>Virology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Peres-Bota, Daliana</creatorcontrib><creatorcontrib>Rodriguez, Hector</creatorcontrib><creatorcontrib>Dimopoulos, George</creatorcontrib><creatorcontrib>DaRos, Alessandra</creatorcontrib><creatorcontrib>Mélot, Christian</creatorcontrib><creatorcontrib>Struelens, Marc J</creatorcontrib><creatorcontrib>Vincent, Jean-Louis</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Peres-Bota, Daliana</au><au>Rodriguez, Hector</au><au>Dimopoulos, George</au><au>DaRos, Alessandra</au><au>Mélot, Christian</au><au>Struelens, Marc J</au><au>Vincent, Jean-Louis</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Are infections due to resistant pathogens associated with a worse outcome in critically ill patients?</atitle><jtitle>The Journal of infection</jtitle><addtitle>J Infect</addtitle><date>2003-11-01</date><risdate>2003</risdate><volume>47</volume><issue>4</issue><spage>307</spage><epage>316</epage><pages>307-316</pages><issn>0163-4453</issn><eissn>1532-2742</eissn><coden>JINFD2</coden><abstract>Objectives. To evaluate the outcome of critically ill patients infected with antimicrobial resistant microorganisms, and to analyse the factors involved in the development of antimicrobial resistance.
Methods. All patients admitted to a 31-bed mixed medico-surgical intensive care unit who developed a nosocomial infection were prospectively followed until discharge or death.
Results. Of 949 consecutive patients admitted, 186 developed a nosocomial infection: 79 with an antimicrobial-resistant pathogen and 107 with susceptible strains. The lungs were the main source of infections in both groups. The main resistant microorganisms were
Enterobacter aerogenes, methicillin resistant
Staphylococcus aureus (MRSA), and
Enterobacter cloacae. The main susceptible microorganisms were
Enterobacter spp., methicillin susceptible
S. aureus (MSSA), and
Proteus mirabilis. Patients infected with resistant strains had a longer length of stay prior to infection (9±4 vs. 5±3 days), longer total length of stay (18±16 vs. 11±7 days), longer duration of mechanical ventilation (12±15 vs. 6±7 days), and more severe coagulation, liver, and renal dysfunction (all
p<0.05). The maximum degrees of organ failure during the ICU stay, and the respiratory dysfunction, but not infection with a resistant pathogen, were independent predictors for death. Multivariate logistic regression revealed previous use of multiple antibiotics, duration of length of stay prior to infection, and the degree of liver failure as independent factors for development of infection with resistant organisms.
Conclusions. Infection with antimicrobial resistant microorganisms is not an independent predictor for death. The development of antimicrobial resistance is related to the previous use of multiple antibiotics, the ICU length of stay, and the severity of hepatic dysfunction.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>14556755</pmid><doi>10.1016/S0163-4453(03)00100-2</doi><tpages>10</tpages></addata></record> |
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| subjects | Antibiotic resistance Biological and medical sciences Chi-Square Distribution Critical Illness Cross Infection - drug therapy Cross Infection - epidemiology Cross Infection - microbiology Drug Resistance Enterobacter aerogenes Enterobacter cloacae Female Fundamental and applied biological sciences. Psychology General aspects Humans Infection Intensive Care Units Logistic Models Male Medical sciences Microbial Sensitivity Tests Microbiology Middle Aged Outcome Prognosis Prospective Studies Proteus mirabilis Resistant pathogens Risk Factors Staphylococcus aureus Susceptible pathogens Virology |
| title | Are infections due to resistant pathogens associated with a worse outcome in critically ill patients? |
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