Risk factors and outcomes associated with the isolation of polymyxin B and carbapenem-resistant Enterobacteriaceae spp.: A case–control study

Autor: Tse Hsien Koh, Shannon Jing-Yi Lee, Andrea L. Kwa, Cheng-Yee Tang, Thuan Tong Tan, Rick Twee-Hee Ong, Jocelyn Qi-Min Teo, Yiying Cai, Cassandra Wee-Ting Chang, Hui Leck
Rok vydání: 2019
Předmět:
Adult
Male
0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
Carbapenem
Genotype
medicine.drug_class
Polymyxin
030106 microbiology
Carbapenem-resistant enterobacteriaceae
Young Adult
03 medical and health sciences
0302 clinical medicine
Risk Factors
Internal medicine
Drug Resistance
Bacterial
medicine
Humans
Pharmacology (medical)
030212 general & internal medicine
Aged
Polymyxin B
Retrospective Studies
Aged
80 and over
Singapore
biology
business.industry
Enterobacteriaceae Infections
Case-control study
General Medicine
Enterobacter
Odds ratio
Middle Aged
biology.organism_classification
Hospitals
Anti-Bacterial Agents
Carbapenem-Resistant Enterobacteriaceae
Treatment Outcome
Infectious Diseases
Carbapenems
Case-Control Studies
Colistin
Female
business
Multilocus Sequence Typing
medicine.drug
Zdroj: International Journal of Antimicrobial Agents. 53:657-662
ISSN: 0924-8579
Popis: Increasing resistance to polymyxin, a last-line antibiotic, is a growing public health concern worldwide. The primary objective of this study was to identify predictors for the isolation of polymyxin-resistant (PR) carbapenem-resistant Enterobacteriaceae (CRE) among hospitalized patients. The secondary objective was to describe the clinical outcomes of patients with PR-CRE infections. A retrospective case–control study including patients admitted to Singapore General Hospital between June 2012 and June 2016 was conducted. Cases were defined as patients who had clinical cultures from which a PR-CRE was isolated. Controls were randomly selected from patients with polymyxin-susceptible (PS) CRE admitted during the same period, and frequency-matched to site of isolation. We included 37 PR cases and 111 PS controls. Polymyxin resistance was detected predominantly in Enterobacter spp. (54.1%) and Klebsiella pneumoniae (43.2%). Multilocus sequence typing showed little clonal relatedness among the isolates. mcr-1 was detected in two PR-CRE isolates. Multivariable analyses showed that PR-CRE isolation was associated with prior polymyxins (adjusted odds ratio (OR), 21.31; 95% confidence interval (CI), 3.04–150.96) and carbapenem exposures (OR 3.74; CI 1.13–12.44), when adjusted for time at risk and bacteria species. In PR-CRE patients with infections, the 30-day all-cause in-hospital mortality was 50.0% as compared to 38.1% in patients with PS-CRE (P = 0.346). Prior polymyxin and carbapenem exposures were independent risk factors for isolation of PR-CRE. Outcomes of PR-CRE and PS-CRE infections were similar in this study.
Databáze: OpenAIRE
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