Background
Methods
Study design
Study population
Microbiological procedures
Definitions
Data collection
Statistical analysis
Results
Gram negative bacilli isolates | Total GNB | Non-MDR-GNB | MDR-GNB | |||
---|---|---|---|---|---|---|
Resistance mechanisms | Total MDR | |||||
ESBL | CP(MBL) | Other | ||||
Acinetobacter spp
| 56 | 4(21%) | 6 | 34 | 12 | 52(41%) |
Pseudomonas spp
| 32 | 5(26%) | 3 | 19 | 5 | 27(21%) |
Klebsiella pneumoniae
| 42 | 6(32%) | 12 | 19 | 5 | 36(28%) |
Escherichia coli
| 11 | 4(21%) | 6 | 1 | – | 7(5.5%) |
Enterobacter spp
| 4 | – | 2 | 2 | – | 4(3%) |
Citrobacter spp
| 2 | – | 2 | – | 2(1.5%) | |
Total | 147 | 19(100%) | 31(24%) | 75(59%) | 22(17%) | 128(100%) |
Antimicrobial agents | Resistance (%) among bacterial isolates | |||||
---|---|---|---|---|---|---|
Acinetobacter spp (n = 52) | Pseudomonas spp (n = 27) | Klebsiella pneumoniae (n = 36) | Escherichiacoli (n = 7) | Enterobacter spp (n = 4) | Citrobacter spp (n = 2) | |
Levofloxacin | 85 | 88 | 73 | 57 | 100 | 50 |
Ciprofloxacin | 92 | 90 | 82 | 86 | 100 | 100 |
Amikacin | 93 | 89 | 76 | 71 | 100 | 50 |
Gentamycin | 93 | 89 | 79 | 71 | 100 | 50 |
Tobramycin | – | 87 | – | – | – | – |
Chloramphenicol | – | – | 73 | 57 | 100 | 0 |
Cotrimoxazole | 90 | – | 73 | 71 | 100 | 50 |
Ampicillin | – | – | – | 100 | 100 | 100 |
Piperacillin | 93 | 90 | 79 | 100 | 100 | |
Piperacillin- Tazobactam | 86 | 82 | 73 | 100 | 100 | 100 |
Amoxicillin-clavulanate | – | – | 76 | 100 | 100 | 100 |
Ceftazidime | 93 | 92 | 92 | 100 | 100 | 100 |
Cefotaxime | 93 | 92 | 92 | 100 | 100 | 100 |
Cefepime | 87 | 90 | 86 | 100 | 100 | 100 |
Imipenem | 81 | 82 | 69 | 14 | 100 | 0 |
Tigecycline | 58 | 63 | 57 | 14 | 67 | 0 |
Polymixin B | 0 | 0 | 0 | 0 | 0 | 0 |
Colistin Sulphate | 0 | 0 | 0 | 0 | 0 | 0 |
Variables | Uninfected patients; n = 41 | Patients with MDR-GNB; n = 64 | Patients with non-MDR-GNB; n = 10 | p-value |
---|---|---|---|---|
Age (years) | 43.5(28–56) | 53(27–65) | 55(40–60) | 0.27 |
Age categories | ||||
< 65 | 25(61%) | 49(76%) | 8(80%) | 0.18 |
> 65 | 16(39%) | 15(23%) | 2(20%) | |
Sex(M/F) | 19/23 | 28/35 | 4/6 | 0.95 |
Reason for admission | ||||
Cardiovascular | 9(22%) | 16(25%) | 6 (60%) | 0.89 |
Respiratory | 27(66%) | 44 (69%) | 3(30%) | |
Digestive/Liver | 1(2%) | 2(3%) | 0 (0%) | |
Renal | 1(2%) | 2(3%) | 1 (10%) | |
Neurological | 3(7%) | 0 (0%) | 0(0%) | |
Medical/Surgical admission | 35/6 | 50/14 | 7/3 | 0.47 |
CCI Score | 0(0–2) | 1(0–3) | 1(0–1) | 0.77 |
APACHE Score | ||||
At 24 h | 13.5(11–16) | 16(12–21) | 13(12–15) | 0.15 |
At 48 h | 13(11–15) | 17(12–20) | 13(12–14) | 0.08 |
Duration of ventilation | 0(0–7) | 10(6–16) | 7.5(6–11) | 0.22 |
Previous antibiotic therapy | 17(41%) | 61(95%) | 6(60%) | < 0.001 |
Aminoglycoside | 5(12%) | 18(28%) | 2(20%) | 0.13 |
Fluoroquinolone | 3(7%) | 20(31%) | 2(20%) | 0.009 |
Macrolide | 3(7%) | 13(20%) | 2(20%) | 0.15 |
Beta-lactam/Beta-lactamase inhibitor | 4(10%) | 27(42%) | 4(40%) | 0.001 |
Cephalosporin | 5(12%) | 10(16%) | 0(0%) | 0.49 |
Carbapenem | 1(2%) | 22((34%) | 0(0%) | < 0.001 |
Tigecycline | 0(0%) | 4(6%) | 0(0%) | 0.29 |
Clindamycin | 0(0%) | 6(9%) | 0(0%) | 0.12 |
Vancomycin or teicoplanin | 0(0%) | 23(36%) | 1(10%) | < 0.001 |
Metronidazole | 0(0%) | 7(11%) | 0(0%) | 0.06 |
Duration of prior antibiotics used (days) | 0(0–6) | 7(6–8) | 4(0–5) | < 0.001 |
Health-care-associated infection | 61(95%) | 2(20%) | < 0.001 |
Outcome | Uninfected patients n = 41 | Patients with MDR-GNB n = 64 | Patients with non-MDR-GNB n = 10 | p-value |
---|---|---|---|---|
In-hospital-mortality | 4(10%) | 24 (38%) | 2 (20%) | 0.007 |
Discharged | 37 (90%) | 40 (62%) | 8 (80%) | 0.007 |
ICU stay | 9(5–12) | 13(8–18) | 9(7–12) | 0.43 |
Hospital stay | 11(8–17) | 14(10–21) | 9(7–15) | 0.93 |
Variables | Univariate analysis | Multivariate analysis | ||
---|---|---|---|---|
Odds ratio (95% CI) | p value | Odds ratio (95% CI) | p value | |
MDR GNBa | 5.46(1.72–17.26) | 0.004 | 4.71(1.42–15.54) | 0.01 |
Non- MDR GNBa | 2.37(0.36–15.26) | 0.36 | 2.60(0.38–17.83) | 0.32 |
Age | 1.00(0.98–1.03) | 0.50 | 1.001(0.96–1.03) | 0.95 |
Male | 0.70(0.29–1.66) | 0.42 | 0.59(0.23–1.53) | 0.28 |
CCI Score | 1.15(0.84–1.56) | 0.36 | 1.05(0.63–1.72) | 0.84 |
APACHE 24 h | 1.07(1.00–1.16) | 0.04 | 1.04(0.91–1.20) | 0.48 |
APACHE 48 h | 1.09(1.00–1.17) | 0.02 | 0.38(0.89–1.17) | 0.72 |