Clinical epidemiology of carbapenem-resistant gram-negative sepsis among hospitalized patients: Shifting burden of disease?
| Autor: | Michael J. Durkin, Scott T. Micek, Nicholas Hampton, David J. Ritchie, Carey-Ann D. Burnham, Nicholas S. Britt, Marin H. Kollef |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Epidemiology Hospitalized patients 030106 microbiology Population Gram negative sepsis Carbapenem-resistant enterobacteriaceae medicine.disease_cause Article Sepsis 03 medical and health sciences Internal medicine Drug Resistance Bacterial Gram-Negative Bacteria medicine Humans education Inpatients education.field_of_study Pseudomonas aeruginosa business.industry Health Policy Public health Public Health Environmental and Occupational Health Retrospective cohort study medicine.disease Anti-Bacterial Agents Infectious Diseases Carbapenems Gram-Negative Bacterial Infections business |
| Zdroj: | American Journal of Infection Control. 46:1092-1096 |
| ISSN: | 0196-6553 |
| DOI: | 10.1016/j.ajic.2018.03.013 |
| Popis: | Infections caused by carbapenem-resistant gram-negative bacilli are an emerging public health threat. However, there is a paucity of data examining comparative incidence rates, risk factors, and outcomes in this population.This single-center retrospective cohort study was conducted at an urban tertiary-care academic medical center. We included patients admitted from 2012 to 2015 who met the following criteria: i) age ≥ 18 years; and ii) culture positive for carbapenem-resistant Enterobacteriaceae (CRE) or carbapenem-resistant non-Enterobacteriaceae (CRNE) from any site. Exclusion criteria were: i) 2 systemic inflammatory response criteria; ii) cystic fibrosis; and iii) no targeted treatment. We evaluated hospital survival by Cox regression and year-by-year differences in the distribution of cases by the Cochran-Armitage test.448 patients were analyzed (CRE, n = 111 [24.8%]; CRNE, n = 337 [75.2%]). CRE sepsis cases increased significantly over the study period (P .001), driven primarily by increasing incidence of Enterobacter spp. infection (P = .004). No difference was observed in hospital survival between patients with CRE versus CRNE sepsis (hazard ratio [HR], 1.29; 95% confidence interval [CI], 0.83-2.02; P = .285), even after adjusting for confounding factors (adjusted HR, 1.08; 95% CI, 0.62-1.87; P = .799).Clinical outcomes did not differ between patients with CRE versus CRNE sepsis. Dramatic increases in CRE, particularly Enterobacter spp., appear to be causing a shift in the burden of clinically significant carbapenem-resistant gram-negative infection. |
| Databáze: | OpenAIRE |
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