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Dantas LF, Peres IT, Antunes BBDP, Bastos LSL, Hamacher S, Kurtz P, Martin-Loeches I, Bozza FA. Prediction of multidrug-resistant bacteria (MDR) hospital-acquired infection (HAI) and colonisation: A systematic review. Infect Dis Health 2024:S2468-0451(24)00048-8. [PMID: 39160126 DOI: 10.1016/j.idh.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND Hospital-Acquired Infections (HAI) represent a public health priority in most countries worldwide. Our main objective was to systematically review the quality of the predictive modeling literature regarding multidrug-resistant gram-negative bacteria in Intensive Care Units (ICUs). METHODS We conducted and reported a Systematic Literature Review according to the recommendations of the PRISMA statement. We analysed the quality of the articles in terms of adherence to the TRIPOD checklist. RESULTS The initial search identified 1935 papers and 15 final articles were included in the review. Most studies analysed used traditional prediction models (logistic regression), and only three developed machine-learning techniques. We noted poor adherence to the main methodological issues recommended in the TRIPOD checklist to develop prediction models, such as handling missing data (20% adherence), model-building procedures (20% adherence), assessing model performance (47% adherence), and reporting performance measures (33% adherence). CONCLUSIONS Our review found few studies that use efficient alternatives to predict the acquisition of multidrug-resistant gram-negative bacteria in ICUs. Furthermore, we noted a lack of strategies for dealing with missing data, feature selection, and imbalanced datasets, a common problem in HAI studies.
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Affiliation(s)
- Leila Figueiredo Dantas
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Igor Tona Peres
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | | | - Leonardo S L Bastos
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Pedro Kurtz
- IDOR, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, Dublin, Ireland.
| | - Fernando Augusto Bozza
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil; IDOR, D'Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil.
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2
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Li Q, Zhou X, Yang R, Shen X, Li G, Zhang C, Li P, Li S, Xie J, Yang Y. Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention - a comprehensive review. Front Public Health 2024; 12:1376513. [PMID: 38601497 PMCID: PMC11004409 DOI: 10.3389/fpubh.2024.1376513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024] Open
Abstract
Intensive care units (ICUs) are specialized environments dedicated to the management of critically ill patients, who are particularly susceptible to drug-resistant bacteria. Among these, carbapenem-resistant Gram-negative bacteria (CR-GNB) pose a significant threat endangering the lives of ICU patients. Carbapenemase production is a key resistance mechanism in CR-GNB, with the transfer of resistance genes contributing to the extensive emergence of antimicrobial resistance (AMR). CR-GNB infections are widespread in ICUs, highlighting an urgent need for prevention and control measures to reduce mortality rates associated with CR-GNB transmission or infection. This review provides an overview of key aspects surrounding CR-GNB within ICUs. We examine the mechanisms of bacterial drug resistance, the resistance genes that frequently occur with CR-GNB infections in ICU, and the therapeutic options against carbapenemase genotypes. Additionally, we highlight crucial preventive measures to impede the transmission and spread of CR-GNB within ICUs, along with reviewing the advances made in the field of clinical predictive modeling research, which hold excellent potential for practical application.
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Affiliation(s)
- Qi Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoshi Zhou
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Rou Yang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xiaoyan Shen
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Chengdu Qingbaijiang District People's Hospital, Chengdu, China
| | - Guolin Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Changji Zhang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Pengfei Li
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Shiran Li
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Jingxian Xie
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Yong Yang
- Department of Pharmacy, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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3
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Michels-Zetsche JD, Gassmann V, Jasuja JK, Neetz B, Höger P, Meis J, Britsch S, Sommerwerck U, Fähndrich S, Bornitz F, Müller MM, Herth FJF, Trudzinski FC. Role of multidrug-resistant bacteria in weaning from invasive mechanical ventilation. Respir Res 2024; 25:69. [PMID: 38317197 PMCID: PMC10840161 DOI: 10.1186/s12931-024-02694-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/18/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Although multidrug-resistant bacteria (MDR) are common in patients undergoing prolonged weaning, there is little data on their impact on weaning and patient outcomes. METHODS This is a retrospective analysis of consecutive patients who underwent prolonged weaning and were at a university weaning centre from January 2018 to December 2020. The influence of MDR colonisation and infection on weaning success (category 3a and 3b), successful prolonged weaning from invasive mechanical ventilation (IMV) with or without the need for non-invasive ventilation (NIV) compared with category 3c (weaning failure 3cI or death 3cII) was investigated. The pathogen groups considered were: multidrug-resistant gram-negative bacteria (MDRGN), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus spp. (VRE). RESULTS A total of 206 patients were studied, of whom 91 (44.2%) showed evidence of MDR bacteria (32% VRE, 1.5% MRSA and 16% MDRGN), with 25 patients also meeting the criteria for MDR infection. 70.9% of the 206 patients were successfully weaned from IMV, 8.7% died. In 72.2% of cases, nosocomial pneumonia and other infections were the main cause of death. Patients with evidence of MDR (infection and colonisation) had a higher incidence of weaning failure than those without evidence of MDR (48% vs. 34.8% vs. 21.7%). In multivariate analyses, MDR infection (OR 4.9, p = 0.004) was an independent risk factor for weaning failure, along with male sex (OR 2.3, p = 0.025), Charlson Comorbidity Index (OR 1.2, p = 0.027), pH (OR 2.7, p < 0.001) and duration of IMV before admission (OR 1.01, p < 0.001). In addition, MDR infection was the only independent risk factor for death (category 3cII), (OR 6.66, p = 0.007). CONCLUSION Patients with MDR infection are significantly more likely to die during the weaning process. There is an urgent need to develop non-antibiotic approaches for the prevention and treatment of MDR infections as well as clinical research on antibiotic stewardship in prolonged weaning as well as in ICUs.
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Affiliation(s)
- Julia D Michels-Zetsche
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany.
| | - Vicky Gassmann
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
| | - Jasmin K Jasuja
- Department for Infectious Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Benjamin Neetz
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
| | - Philipp Höger
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
| | - Jan Meis
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Simone Britsch
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, European Center for Angioscience (ECAS), University Medical Center Mannheim, German Center for Cardiovascular Research (DZHK), Partner Site, Heidelberg/Mannheim, Germany
| | - Urte Sommerwerck
- Department of Pneumology, Krankenhaus der Augustinerinnen Cologne, Cologne, Germany
| | - Sebastian Fähndrich
- Department of Pneumology, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Florian Bornitz
- Department of Pneumology and Internal Intensive Care Medicine, Asklepios Hospital Barmbek, Hamburg, Germany
| | - Michael M Müller
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
| | - Felix J F Herth
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
| | - Franziska C Trudzinski
- Department of Pneumology and Critical Care, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Röntgenstrasse 1, D-69126, Heidelberg, Germany
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Dai Y, Zhang L, Pan T, Shen Z, Meng T, Wu J, Gu F, Wang X, Tan R, Qu H. The ICU-CARB score: a novel clinical scoring system to predict carbapenem-resistant gram-negative bacteria carriage in critically ill patients upon ICU admission. Antimicrob Resist Infect Control 2023; 12:118. [PMID: 37898771 PMCID: PMC10613373 DOI: 10.1186/s13756-023-01326-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND With the widespread spread of carbapenem-resistant gram-negative bacteria (CR-GNB) in medical facilities, the carriage of CR-GNB among critically ill patients has become a significant concern in intensive care units (ICU). This study aimed to develop a scoring system to identify CR-GNB carriers upon ICU admission. METHODS Consecutive critically ill patients admitted to the ICU of Shanghai Ruijin Hospital between January 2017 and December 2020 were included. The patients were then divided into training and testing datasets at a 7:3 ratio. Parameters associated with CR-GNB carriage were identified using least absolute shrinkage and selection operator regression analysis. Each parameter was assigned a numerical score ranging from 0 to 100 using logistic regression analysis. Subsequently, a four-tier risk-level system was developed based on the cumulative scores, and assessed using the area under the receiver operating characteristic curve (AUC). RESULTS Of the 1736 patients included in this study, the prevalence of CR-GNB carriage was 10.60%. The clinical scoring system including seven variables (neurological disease, high-risk department history, length of stay ≥ 14 days, ICU history, invasive mechanical ventilation, gastrointestinal tube placement, and carbapenem usage) exhibited promising predictive capabilities. Patients were then stratified using the scoring system, resulting in CR-GNB carriage rates of 2.4%, 12.0%, 36.1%, and 57.9% at the respective risk levels (P < 0.001). Furthermore, the AUC of the developed model in the training set was calculated to be 0.82 (95% CI, 0.78-0.86), while internal validation yielded an AUC of 0.83 (95% CI, 0.77-0.89). CONCLUSIONS The ICU-CARB Score serves as a straightforward and precise tool that enables prompt evaluation of the risk of CR-GNB carriage at the time of ICU admission, thereby facilitating the timely implementation of targeted pre-emptive isolation.
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Affiliation(s)
- Yunqi Dai
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ling Zhang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Pan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Shen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Tianjiao Meng
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Wu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Feifei Gu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoli Wang
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ruoming Tan
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hongping Qu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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5
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Liao Q, Feng Z, Lin H, Zhou Y, Lin J, Zhuo H, Chen X. Carbapenem-resistant gram-negative bacterial infection in intensive care unit patients: Antibiotic resistance analysis and predictive model development. Front Cell Infect Microbiol 2023; 13:1109418. [PMID: 36794004 PMCID: PMC9922834 DOI: 10.3389/fcimb.2023.1109418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/16/2023] [Indexed: 02/03/2023] Open
Abstract
In this study, we analyzed the antibiotic resistance of carbapenem-resistant gram-negative bacteria (CR-GNB) in intensive care unit (ICU) patients and developed a predictive model. We retrospectively collected the data of patients with GNB infection admitted to the ICU of the First Affiliated Hospital of Fujian Medical University, who were then divided into a CR and a carbapenem-susceptible (CS) group for CR-GNB infection analysis. Patients admitted between December 1, 2017, and July 31, 2019, were assigned to the experimental cohort (n = 205), and their data were subjected to multivariate logistic regression analysis to identify independent risk factors for constructing the nomogram-based predictive model. Patients admitted between August 1, 2019, and September 1, 2020, were assigned to the validation cohort for validating the predictive model (n = 104). The Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve analysis were used to validate the model's performance. Overall, 309 patients with GNB infection were recruited. Of them, 97 and 212 were infected with CS-GNB and CR-GNB, respectively. Carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) were the most prevalent CR-GNB. The multivariate logistic regression analysis results of the experimental cohort revealed that a history of combination antibiotic treatments (OR: 3.197, 95% CI: 1.561-6.549), hospital-acquired infection (OR: 3.563, 95% CI: 1.062-11.959) and mechanical ventilation ≥ 7 days (OR: 5.096, 95% CI: 1.865-13.923) were independent risk factors for CR-GNB infection, which were then used for nomogram construction. The model demonstrated a good fit of observed data (p = 0.999), with an area under the ROC curve (AUC) of 0.753 (95% CI: 0.685-0.820) and 0.718 (95% CI: 0.619-0.816) for the experimental and validation cohort, respectively. The decision curve analysis results suggested that the model has a high practical value for clinical practice. The Hosmer-Lemeshow test indicated a good fit of the model in the validation cohort (p-value, 0.278). Overall, our proposed predictive model exhibited a good predictive value in identifying patients at high risk of developing CR-GNB infection in the ICU and could be used to guide preventive and treatment measures.
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Affiliation(s)
- Qiuxia Liao
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Zhi Feng
- Department of Thoracic Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Hairong Lin
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Ye Zhou
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jiandong Lin
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Huichang Zhuo
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaoli Chen
- Department of Intensive Care Unit, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China,Department of Intensive Care Unit, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, China,*Correspondence: Xiaoli Chen,
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Gomes MZR, Braga DQ, Pinheiro DOBP, Verduc RCAS, dos Reis LV, de Lima EM, Lourenço ND, Cid PA, Beck DS, Pinheiro LHZ, Tonhá JPS, de Sousa LS, Dias MLS, da Silva Machado AA, Castro MM, Dutra VPR, de Mello LS, da Silva MC, Tozo TM, Mathuiy YR, de Abreu Rosas LLP, Barros PCM, da Silva JO, da Silva PP, Bandeira CS, de Sant′Anna Reis Di Chiara Salgado SM, de Oliveira Alves MZ, Santos RQ, Marques JA, Rodrigues CAS, dos Santos Gomes Junior SC. Predictive Score for Carbapenem-Resistant Gram-Negative Bacilli Sepsis: Single-Center Prospective Cohort Study. Antibiotics (Basel) 2022; 12:21. [PMID: 36671222 PMCID: PMC9854893 DOI: 10.3390/antibiotics12010021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 12/28/2022] Open
Abstract
A clinical-epidemiological score to predict CR-GNB sepsis to guide empirical antimicrobial therapy (EAT), using local data, persists as an unmet need. On the basis of a case-case-control design in a prospective cohort study, the predictive factors for CR-GNB sepsis were previously determined as prior infection, use of mechanical ventilation and carbapenem, and length of hospital stay. In this study, each factor was scored according to the logistic regression coefficients, and the ROC curve analysis determined its accuracy in predicting CR-GNB sepsis in the entire cohort. Among the total of 629 admissions followed by 7797 patient-days, 329 single or recurrent episodes of SIRS/sepsis were enrolled, from August 2015 to March 2017. At least one species of CR-GNB was identified as the etiology in 108 (33%) episodes, and 221 were classified as the control group. The cutoff point of ≥3 (maximum of 4) had the best sensitivity/specificity, while ≤1 showed excellent sensitivity to exclude CR-GNB sepsis. The area under the curve was 0.80 (95% CI: 0.76-0.85) and the number needed to treat was 2.0. The score may improve CR-GNB coverage and spare polymyxins with 22% (95% CI: 17-28%) adequacy rate change. The score has a good ability to predict CR-GNB sepsis and to guide EAT in the future.
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Affiliation(s)
- Marisa Zenaide Ribeiro Gomes
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil
- Hospital Infection Control Committee, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University, Rio de Janeiro 20551-030, Brazil
| | - Douglas Quintanilha Braga
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil
| | - Debora Otero Britto Passos Pinheiro
- Hospital Infection Control Committee, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University, Rio de Janeiro 20551-030, Brazil
| | - Renata Cristina Amorim Silveira Verduc
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil
| | - Letícia Vellozo dos Reis
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil
| | - Elisangela Martins de Lima
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil
| | - Newton Dias Lourenço
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil
| | - Patrícia Aquen Cid
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Debora Souza Beck
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Luiz Henrique Zanata Pinheiro
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - João Pedro Silva Tonhá
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Luiza Silva de Sousa
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Mayra Lopes Secundo Dias
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Amanda Aparecida da Silva Machado
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Murillo Marçal Castro
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Vitoria Pinson Ruggi Dutra
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Luciana Sênos de Mello
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Maxuel Cassiano da Silva
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Thaisa Medeiros Tozo
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil
| | - Yann Rodrigues Mathuiy
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Lucas Lameirão Pinto de Abreu Rosas
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Paulo Cesar Mendes Barros
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil
| | - Jeane Oliveira da Silva
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Priscila Pinho da Silva
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | - Carolina Souza Bandeira
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil
| | | | | | - Roberto Queiroz Santos
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil
| | - José Aurélio Marques
- Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil
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Lin TL, Chang PH, Chen IL, Lai WH, Chen YJ, Li WF, Lee IK, Wang CC. Risk factors and mortality associated with multidrug-resistant gram-negative bacterial infection in adult patients with abdominal surgery. J Hosp Infect 2021; 119:22-32. [PMID: 34627933 DOI: 10.1016/j.jhin.2021.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/09/2021] [Accepted: 09/23/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Multidrug-resistant (MDR) gram-negative bacterial (GNB) infections remain a significant cause of morbidity and mortality among surgical patients. The objective of our study was to recognize the risk factors for MDR GNB infection in patients with abdominal surgery and determine the predictors independently associated with death. METHODS From 2010 to 2017, a retrospective cohort study was conducted among patients with abdominal surgery admitted in surgical intensive care unit (ICU). Patients with GNB infections were included for analyses. RESULTS A total of 364 patients with abdominal surgery experienced GNB infections, among them, 117 (32.1%) were MDR GNB infection. Of 133 MDR GNB isolates, the most frequent isolate was Escherichia coli (45.1%). Patients with MDR GNB infection had significantly longer ventilator days and hospital stay, as well as higher 30-day and in-hospital mortality compared to non-MDR GNB patients. Multivariable analysis showed longer length of pre-ICU stay, surgical re-exploration, receipt of group 2 carbapenems (e.g. imipenem, meropenem and doripenem) and fluoroquinolones, and higher total bilirubin were independent risk factors for the acquisition of MDR GNB infection. Predictors for 30-day mortality among patients with MDR GNB infection were chronic kidney disease, receipt of group 2 carbapenems and inappropriate empirical antimicrobial therapy. CONCLUSIONS This study provides important information about the risk factors for subsequent MDR GNB infection and 30-day mortality among the patients with abdominal surgery.
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Affiliation(s)
- Ting-Lung Lin
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Hsun Chang
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - I-Ling Chen
- Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Hung Lai
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ying-Ju Chen
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Feng Li
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ing-Kit Lee
- Chang Gung University College of Medicine, Kaohsiung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
| | - Chih-Chi Wang
- Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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8
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Gutsche JT, Grant MC, Kiefer JJ, Ghadimi K, Lane-Fall MB, Mazzeffi MA. The Year in Cardiothoracic Critical Care: Selected Highlights from 2019. J Cardiothorac Vasc Anesth 2020; 36:45-57. [PMID: 33051148 DOI: 10.1053/j.jvca.2020.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/11/2022]
Abstract
In 2019, cardiothoracic and vascular critical care remained an important focus and subspecialty. This article continues the annual series to review relevant contributions in postoperative critical care that may affect the cardiac anesthesiologist. Herein, the pertinent literature published in 2019 is explored and organized by organ system.
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Affiliation(s)
- J T Gutsche
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - M C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - J J Kiefer
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - K Ghadimi
- Department of Anesthesiology and Critical Care, Duke University, Durham, NC
| | - M B Lane-Fall
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - M A Mazzeffi
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, MD
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9
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Boyd SE, Vasudevan A, Moore LSP, Brewer C, Gilchrist M, Costelloe C, Gordon AC, Holmes AH. Validating a prediction tool to determine the risk of nosocomial multidrug-resistant Gram-negative bacilli infection in critically ill patients: A retrospective case-control study. J Glob Antimicrob Resist 2020; 22:826-831. [PMID: 32712381 DOI: 10.1016/j.jgar.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/07/2020] [Accepted: 07/01/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Singapore GSDCS score was developed to enable clinicians predict the risk of nosocomial multidrug-resistant Gram-negative bacilli (RGNB) infection in critically ill patients. We aimed to validate this score in a UK setting. METHOD A retrospective case-control study was conducted including patients who stayed for more than 24h in intensive care units (ICUs) across two tertiary National Health Service hospitals in London, UK (April 2011-April 2016). Cases with RGNB and controls with sensitive Gram-negative bacilli (SGNB) infection were identified. RESULTS The derived GSDCS score was calculated from when there was a step change in antimicrobial therapy in response to clinical suspicion of infection as follows: prior Gram-negative organism, Surgery, Dialysis with end-stage renal disease, prior Carbapenem use and intensive care Stay of more than 5 days. A total of 110 patients with RGNB infection (cases) were matched 1:1 to 110 geotemporally chosen patients with SGNB infection (controls). The discriminatory ability of the prediction tool by receiver operating characteristic curve analysis in our validation cohort was 0.75 (95% confidence interval 0.65-0.81), which is comparable with the area under the curve of the derivation cohort (0.77). The GSDCS score differentiated between low- (0-1.3), medium- (1.4-2.3) and high-risk (2.4-4.3) patients for RGNB infection (P<0.001) in a UK setting. CONCLUSION A simple bedside clinical prediction tool may be used to identify and differentiate patients at low, medium and high risk of RGNB infection prior to initiation of prompt empirical antimicrobial therapy in the intensive care setting.
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Affiliation(s)
- Sara E Boyd
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool L69 3GE, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK; Imperial College Healthcare NHS Trust, London, UK.
| | | | - Luke S P Moore
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK; North West London Pathology, Fulham Palace Road, London W6 8RF, UK; Chelsea and Westminster NHS Foundation Trust, London, UK
| | | | - Mark Gilchrist
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK; Imperial College Healthcare NHS Trust, London, UK
| | - Ceire Costelloe
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK
| | - Anthony C Gordon
- Imperial College Healthcare NHS Trust, London, UK; Section of Anaesthetics, Pain Medicine & Intensive Care, Imperial College London, London, UK
| | - Alison H Holmes
- National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0HS, UK; Imperial College Healthcare NHS Trust, London, UK
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10
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Morris S, Cerceo E. Trends, Epidemiology, and Management of Multi-Drug Resistant Gram-Negative Bacterial Infections in the Hospitalized Setting. Antibiotics (Basel) 2020; 9:E196. [PMID: 32326058 PMCID: PMC7235729 DOI: 10.3390/antibiotics9040196] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022] Open
Abstract
The increasing prevalence of antibiotic resistance is a threat to human health, particularly within vulnerable populations in the hospital and acute care settings. This leads to increasing healthcare costs, morbidity, and mortality. Bacteria rapidly evolve novel mechanisms of resistance and methods of antimicrobial evasion. Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Acinetobacter baumannii have all been identified as pathogens with particularly high rates of resistance to antibiotics, resulting in a reducing pool of available treatments for these organisms. Effectively combating this issue requires both preventative and reactive measures. Reducing the spread of resistant pathogens, as well as reducing the rate of evolution of resistance is complex. Such a task requires a more judicious use of antibiotics through a better understanding of infection epidemiology, resistance patterns, and guidelines for treatment. These goals can best be achieved through the implementation of antimicrobial stewardship programs and the development and introduction of new drugs capable of eradicating multi-drug resistant Gram-negative pathogens (MDR GNB). The purpose of this article is to review current trends in MDR Gram-negative bacterial infections in the hospitalized setting, as well as current guidelines for management. Finally, new and emerging antimicrobials, as well as future considerations for combating antibiotic resistance on a global scale are discussed.
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Affiliation(s)
- Sabrina Morris
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA;
| | - Elizabeth Cerceo
- Cooper Medical School of Rowan University, Camden, NJ 08103, USA;
- Department of Hospitalist Medicine, Cooper University Hospital, Camden, NJ 08103, USA
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