Risk factors for mortality in patients with ventilator-associated pneumonia caused by carbapenem-resistant Enterobacteriaceae
| Autor: | Suellen Stallbaum, Jaime L. Rocha, Felipe Francisco Tuon, Maria Esther Graf, Roberto Pecoit-Filho, Lavinia N. Arend, Alexandre Bueno Merlini |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Male Carbapenem Time Factors Polymyxin lcsh:QR1-502 Carbapenem-resistant enterobacteriaceae Tigecycline lcsh:Microbiology Risk Factors Hospital Mortality media_common Aged 80 and over Medicine(all) Ventilator-associated pneumonia Enterobacteriaceae Infections Pneumonia Ventilator-Associated Enterobacter aerogenes Middle Aged Anti-Bacterial Agents Klebsiella pneumoniae Infectious Diseases Treatment Outcome Drug Therapy Combination Female medicine.drug Microbiology (medical) Drug Adult medicine.medical_specialty medicine.drug_class media_common.quotation_subject 030106 microbiology Carbapenemase-producing Klebsiella pneumoniae Statistics Nonparametric lcsh:Infectious and parasitic diseases 03 medical and health sciences Internal medicine Drug Resistance Bacterial medicine Humans In patient lcsh:RC109-216 Mortality Intensive care medicine Aged Retrospective Studies business.industry Retrospective cohort study medicine.disease Treatment Cross-Sectional Studies Logistic Models Carbapenems Risk factors business |
| Zdroj: | Brazilian Journal of Infectious Diseases v.21 n.1 2017 Brazilian Journal of Infectious Diseases Brazilian Society of Infectious Diseases (BSID) instacron:BSID Brazilian Journal of Infectious Diseases, Vol 21, Iss 1, Pp 1-6 (2017) Brazilian Journal of Infectious Diseases, Volume: 21, Issue: 1, Pages: 1-6, Published: FEB 2017 |
| Popis: | Background: The ideal therapeutic option for ventilator associated pneumonia caused by carbapenem-resistant Enterobacteriaceae is not defined. The aim of this study was to assess mortality-associated risk factors in patients with VAP by CRE and determine the outcome of several treatment options. Methods: This was a retrospective study performed in two tertiary hospitals involving patients with VAP caused by CRE between January 2010 and August 2014. The outcomes were mortality within 30 days of VAP diagnosis and overall mortality during hospital admission. Risk factors for mortality were assessed by comparing variables of survivors and non-survivors. Results: One hundred and twelve patients with CRE-VAP were included, 73 (65%) male, median age 56 years. The 30-day mortality was 57.1% and the overall hospital mortality was 67%. In the binary logistic regression analysis, only age >50 years was independently associated to increased mortality. Polymyxin was the most used drug (47.5%), followed by tigecycline (29.2%) and aminoglycosides (2.4%). Combined therapy with two active drugs was used by 17 patients (20.8%). No therapeutic option was independently associated to survival. However, combined therapy with two active drugs was superior to the therapy with a single active drug when inappropriate therapy was the comparator (p = 0.044). The addition of carbapenem was not associated with increased survival. Conclusion: The best therapeutic option for VAP by CRE is still not completely defined, but the therapy with at least two active drugs was superior in this study. Keywords: Carbapenemase-producing Klebsiella pneumoniae, Ventilator-associated pneumonia, Risk factors, Mortality, Treatment |
| Databáze: | OpenAIRE |
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