Characterizing non-linear effects of hospitalisation duration on antimicrobial resistance in respiratory isolates: an analysis of a prospective nationwide surveillance system
| Autor: | R. Sommerstein, A. Atkinson, E.F. Lo Priore, A. Kronenberg, J. Marschall, A. Burnens, A. Cherkaoui, O. Dubuis, A. Egli, V. Gaia, D. Koch, S.L. Leib, S. Luyet, P. Nordmann, V. Perreten, J.-C. Piffaretti, G. Prod’hom, J. Schrenzel, A.F. Widmer, G. Zanetti, R. Zbinden |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Male
0301 basic medicine Microbiology (medical) Staphylococcus aureus medicine.medical_specialty Pediatrics Cefepime Respiratory System 030106 microbiology Enterobacter Microbial Sensitivity Tests Amoxicillin-Potassium Clavulanate Combination medicine.disease_cause Hospital-acquired pneumonia 03 medical and health sciences 0302 clinical medicine Antibiotic resistance Drug Resistance Bacterial Epidemiology Escherichia coli medicine Humans 030212 general & internal medicine Oxacillin Retrospective Studies Cross Infection Pseudomonas aeruginosa business.industry Confounding Pneumonia General Medicine Length of Stay Middle Aged medicine.disease Anti-Bacterial Agents Cephalosporins Hospitalization Klebsiella pneumoniae Streptococcus pneumoniae Infectious Diseases Female business medicine.drug |
| Zdroj: | Clinical Microbiology and Infection. 24:45-52 |
| ISSN: | 1198-743X |
| DOI: | 10.1016/j.cmi.2017.05.018 |
| Popis: | Objectives Our objective was to systematically study the influence of length of hospital stay on bacterial resistance in relevant respiratory tract isolates. Methods Using prospective epidemiological data from the National Swiss Antibiotic Resistance Surveillance System, susceptibility testing results for respiratory isolates retrospectively retrieved from patients hospitalised between 2008 and 2014 were compiled. Generalized additive models were used to illustrate resistance rates relative to hospitalisation duration and to adjust for co-variables. Results In all, 19 622 isolates of six relevant and predominant species were included. Resistance patterns for the predominant species showed a species-specific and antibiotic-resistance-specific profile in function of hospitalisation duration. The oxacillin resistance profile in Staphylococcus aureus isolates was constantly increasing (monophasic). The pattern of resistance to cefepime in Pseudomonas aeruginosa was biphasic with a decreasing resistance rate for the first 5 days of hospitalisation and an increase for days 6–30. A different biphasic pattern occurred in Escherichia coli regarding amoxicillin-clavulanic acid resistance: odds/day increased for the first 7 days of hospitalisation and then remained stable for days 8–30. In the adjusted models epidemiological characteristics such as age, ward type, hospital type and linguistic region were identified as relevant co-variables for the resistance rates. The contribution of these confounders was specific to the individual species/antibiotic resistance models. Conclusions Resistance rates do not follow a dichotomic pattern (early versus late nosocomial) as suggested by current hospital-acquired pneumonia treatment guidelines. Duration of hospitalisation rather appears to have a more complex and non-linear relationship with bacterial resistance in hospital-acquired pneumonia, also depending on host and environmental factors. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|