Mortality and Length of Stay in Patients with Bloodstream Infections Due to Drug-Susceptible Versus Drug-Resistant Gram-Negative Bacteria
International Journal of Infectious Diseases and Therapy
Volume 4, Issue 3, September 2019, Pages: 33-39
Received: Jul. 26, 2019;
Accepted: Aug. 20, 2019;
Published: Sep. 6, 2019
Views 214 Downloads 41
Jamal Wadi Al Ramahi, Department of Medicine, School of Medicine, University of Jordan, Amman, Jordan
Ahmad Al-Abdouh, Department of Internal Medicine, Al Takhassusi Hospital, Amman, Jordan
Nour Hasan, Department of Pharmacy, Al Khalidi Hospital, Amman, Jordan
Ghayda Haddad, Department of Pharmacy, Al Khalidi Hospital, Amman, Jordan
Mohammad Al Baba, Department of Internal Medicine, Al Takhassusi Hospital, Amman, Jordan
Ahmad Al Aaraj, Department of Internal Medicine, Al Takhassusi Hospital, Amman, Jordan
Mahmoud Fakhri, Department of Medicine, Jordan Hospital, Amman, Jordan
Lamya Abu Shanab, Department of Pharmacy, Jordan Hospital, Amman, Jordan
Belal Harara, Department of Intensive Care Unit, Al Khalidi Hospital, Amman, Jordan
Mahmoud Barbarawi, Department of Internal Medicine, Al Takhassusi Hospital, Amman, Jordan
A prospective patient surveillance and analysis in three urban hospitals with the objective of comparing the mortality rates among patients with antimicrobials-sensitive versus -resistant gram-negative bacterial bloodstream infections. The analysis focused on the rates of in-hospital and 28-days mortality. There were 189 patients with BSI, drug-susceptible gram-negative bacteria (DSGNB) 40.7%, multi-drug resistant bacteria (MDRGNB) 42.3% and extensive-drug resistant bacteria (XDRGNB) 16.9%. The mean age, gender, SOFA score on the initial evaluation, APACHE II score, comorbidities, identified bacterial species, and BSI-associated diagnoses were not statistically different except for VAP (P = 0.000) in the XDRGNB infected patients. In-hospital and 28-days mortalities were significantly higher in the XDRGNB-BSI group (P = 0.000), and ICU length of stay (P = 0.000). XDRGNB-BSI was significantly higher in inappropriate and delayed treated patients (P < 0.05). Logistic regression analysis demonstrated no significant interaction for the 28 days mortality neither with the admission diagnoses, the antimicrobial class (except aminoglycosides), the comorbidities (except for solid tumors) (P > 0.05, Nagelkerke R2 < 0.4). In conclusion, BSI due to multiple class antimicrobial resistance has higher mortality and ICU length of stay.
Jamal Wadi Al Ramahi,
Mohammad Al Baba,
Ahmad Al Aaraj,
Lamya Abu Shanab,
Mortality and Length of Stay in Patients with Bloodstream Infections Due to Drug-Susceptible Versus Drug-Resistant Gram-Negative Bacteria, International Journal of Infectious Diseases and Therapy.
Vol. 4, No. 3,
2019, pp. 33-39.
Helen W. Boucher, George H. Talbot, Daniel K. Benjamin Jr, John Bradley, Robert J. Guidos, Ronald N. Jones, Barbara E. Murray, Robert A. Bonomo, and David Gilbert, for the Infectious Diseases Society of Americaa10 × ’20 Progress—Development of New Drugs Active Against Gram-Negative Bacilli: An Update From the Infectious Diseases Society of America. Clinical Infectious Diseases 2013; 56 (12): 1685–94.
McGowan Jr JE. Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum. American journal of infection control. 2006 Jun 1; 34 (5): S29-37.
Souli M, Galani I, Giamarellou H. Emergence of extensively drug-resistant and pan-drug-resistant Gram-negative bacilli in Europe. Eurosurveillance. 2008 Nov 20; 13 (47): 19045.
Stijn Blot, Koenraad Vandewoude, Dirk De Bacquer, and Francis Colardyn. Nosocomial Bacteremia Caused by Antibiotic-Resistant Gram-Negative Bacteria in Critically Ill Patients: Clinical Outcome and Length of Hospitalization. Clinical Infectious Diseases 2002; 34: 1600–6.
Yu-Chen Tseng, Jann-Tay Wang, Fe-Lin Lin Wu, Yee-Chun Chen, Wei-Chu Chie, Shan-Chwen Chang. Prognosis of adult patients with bacteremia caused by extensively resistant Acinetobacter baumannii. Diagnostic Microbiology and Infectious Disease (2007); 59: 181–190.
Bodro, Marta, Sabé, Núria, Tubau, Fe, Lladó, Laura, Baliellas, Carme, Roca, Josep Cruzado, Josep, Maria, Carratalà, Jordi. Risk Factors and Outcomes of Bacteremia Caused by Drug-Resistant ESKAPE Pathogens in Solid-Organ Transplant Recipients. Transplantation: 15 November 2013 - Volume 96 - Issue 9 - p 843–849. doi: 10.1097/TP.0b013e3182a049fd.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT and Monnet DL. Multidrug-resistant, extensively drug-resistant and pan-drug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012; 18: 268–281. 10.1111/j.1469-0691.2011.03570.x.
Luna CM, Vujacich P, Niederman MS et al. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest 1997; 111: 676–685.
Davey P G and Marwick C. Appropriate vs. inappropriate antimicrobial therapy. Clin Microbiol Infect 2008; 14 (Suppl. 3): 15–21.
Ibrahim E H, Sherman G, Ward S, Fraser V J and Kollef M H. The Influence of Inadequate Antimicrobial Treatment of Bloodstream Infections on Patient Outcomes in the ICU Setting. Chest 2000; 118; 146-155. DOI: 10.1378/chest.118.1.146.
R. P. Dellinger, Mitchell M. Levy, Andrew Rhodes, Djillali Annane, Herwig Gerlach, Steven M. Opal, Jonathan E. Sevransky, Charles L. Sprung, Ivor S. Douglas, Roman Jaeschke, Tiffany M. Osborn, Mark E. Nunnally, Sean R. Townsend, Konrad Reinhart, Ruth M. Kleinpell, Derek C. Angus, Clifford S. Deutschman, Flavia R. Machado, Gordon D. Rubenfeld, Steven Webb, Richard J. Beale, Jean-Louis Vincent, Rui Moreno. The Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup* Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012. Intensive Care Med (2013) 39: 165–228. DOI 10.1007/s00134-012-2769-8.
Cain SE, Kohn J, Bookstaver PB, Albrecht H, Al-Hasan MN. Stratification of the impact of inappropriate empirical antimicrobial therapy for Gram-negative bloodstream infections by predicted prognosis. Antimicrobial agents and chemotherapy. 2015 Jan 1; 59 (1): 245-50.
Battle SE, Bookstaver PB, Justo JA, Kohn J, Albrecht H, Al-Hasan MN. Association between inappropriate empirical antimicrobial therapy and hospital length of stay in gram-negative bloodstream infections: stratification by prognosis. Journal of Antimicrobial Chemotherapy. 2016 Sep 28; 72 (1): 299-304.
Zilberberg MD, Nathanson BH, Sulham K, Fan W, Shorr AF. Multidrug resistance, inappropriate empiric therapy, and hospital mortality in Acinetobacter baumannii pneumonia and sepsis. Critical Care. 2016 Dec; 20 (1): 221.
Merchant S, Proudfoot EM, Quadri HN, McElroy HJ, Wright WR, Gupta A, Sarpong EM. Risk factors for Pseudomonas aeruginosa infections in Asia-Pacific and the consequences of inappropriate initial antimicrobial therapy: A systematic literature review and meta-analysis. Journal of global antimicrobial resistance. 2018 Sep 1; 14: 33-44.
Harbarth S, Garbino J, Pugin J, Romand JA, Lew D, Pittet D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. The American journal of medicine. 2003 Nov 1; 115 (7): 529-35.
Cheong HS, Kang CI, Wi YM, Ko KS, Chung DR, Lee NY, Song JH, Peck KR. Inappropriate initial antimicrobial therapy as a risk factor for mortality in patients with community-onset Pseudomonas aeruginosa bacteremia. European journal of clinical microbiology & infectious diseases. 2008 Dec 1; 27 (12): 1219-25.
Mauldin PD, Salgado CD, Hansen IS, Durup DT, Bosso JA. Attributable hospital costs and length of stay associated with healthcare-associated infections caused by antibiotic-resistant gram-negative bacteria. Antimicrobial agents and chemotherapy. 2010 Jan 1; 54 (1): 109-15.
Blot S, Vandewoude K, De Bacquer D, Colardyn F. Nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in critically ill patients: clinical outcome and length of hospitalization. Clinical infectious diseases. 2002 Jun 15; 34 (12): 1600-6.
Zhang D, Micek ST, Kollef MH. Time to appropriate antibiotic therapy is an independent determinant of postinfection ICU and hospital lengths of stay in patients with sepsis. Critical care medicine. 2015 Oct 1; 43 (10): 2133-40.
Beganovic M, Costello M, Wieczorkiewicz SM. Effect of matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) alone versus MALDI-TOF MS combined with real-time antimicrobial stewardship interventions on time to optimal antimicrobial therapy in patients with positive blood cultures. Journal of clinical microbiology. 2017 May 1; 55 (5): 1437-45.