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Aydın M, Ergönül Ö, Azap A, Bilgin H, Aydın G, Çavuş SA, Demiroğlu YZ, Alışkan HE, Memikoğlu O, Menekşe Ş, Kaya Ş, Demir NA, Karaoğlan I, Başaran S, Hatipoğlu Ç, Erdinç Ş, Yılmaz E, Tümtürk A, Tezer Y, Demirkaya H, Çakar ŞE, Keske Ş, Tekin S, Yardımcı C, Karakoç Ç, Ergen P, Azap Ö, Mülazımoğlu L, Ural O, Can F, Akalın H. Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections. J Hosp Infect 2017; 98:260-263. [PMID: 29248504 DOI: 10.1016/j.jhin.2017.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 11/26/2017] [Indexed: 10/18/2022]
Abstract
This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality.
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Affiliation(s)
- M Aydın
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Başkent University, Istanbul, Turkey.
| | - Ö Ergönül
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Koç University, Istanbul, Turkey
| | - A Azap
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Ankara University, Ankara, Turkey
| | - H Bilgin
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Marmara University, Istanbul, Turkey
| | - G Aydın
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Ankara University, Ankara, Turkey; Infectious Diseases and Clinical Microbiology Department, Afyonkarahisar Training and Research Hospital, Afyonkarahisar, Turkey
| | - S A Çavuş
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Y Z Demiroğlu
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Başkent University, Adana, Turkey
| | - H E Alışkan
- Clinical Microbiology Department, School of Medicine, Başkent University, Adana, Turkey
| | - O Memikoğlu
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Ankara University, Ankara, Turkey
| | - Ş Menekşe
- Infectious Diseases and Clinical Microbiology Department, SBÜ Kartal Koşuyolu Yüksek İhtisas Hospital, Training and Research Hospital, Istanbul, Turkey
| | - Ş Kaya
- Infectious Diseases and Clinical Microbiology Department, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey
| | - N A Demir
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Selçuk University, Konya, Turkey
| | - I Karaoğlan
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Gaziantep University, Gaziantep, Turkey
| | - S Başaran
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, İstanbul University, Istanbul, Turkey
| | - Ç Hatipoğlu
- Infectious Diseases and Clinical Microbiology Department, Ankara Training and Research Hospital, Ankara, Turkey
| | - Ş Erdinç
- Infectious Diseases and Clinical Microbiology Department, Ankara Training and Research Hospital, Ankara, Turkey
| | - E Yılmaz
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Uludağ University, Bursa, Turkey
| | - A Tümtürk
- Infectious Diseases and Clinical Microbiology Department, Ankara Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - Y Tezer
- Infectious Diseases and Clinical Microbiology Department, Ankara Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
| | - H Demirkaya
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Başkent University, Ankara, Turkey
| | - Ş E Çakar
- Infectious Diseases and Clinical Microbiology Department, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Ş Keske
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Koç University, Istanbul, Turkey
| | - S Tekin
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Koç University, Istanbul, Turkey
| | - C Yardımcı
- Infectious Diseases and Clinical Microbiology Department, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Ç Karakoç
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, İstinye University, Istanbul, Turkey
| | - P Ergen
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Medeniyet University, Istanbul, Turkey
| | - Ö Azap
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Başkent University, Ankara, Turkey
| | - L Mülazımoğlu
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Marmara University, Istanbul, Turkey
| | - O Ural
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Selçuk University, Konya, Turkey
| | - F Can
- Clinical Microbiology Department, School of Medicine, Koç University, Istanbul, Turkey
| | - H Akalın
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Uludağ University, Bursa, Turkey
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Ergönül Ö, Aydin M, Azap A, Başaran S, Tekin S, Kaya Ş, Gülsün S, Yörük G, Kurşun E, Yeşilkaya A, Şimşek F, Yılmaz E, Bilgin H, Hatipoğlu Ç, Cabadak H, Tezer Y, Togan T, Karaoğlan I, İnan A, Engin A, Alışkan HE, Yavuz SŞ, Erdinç Ş, Mulazimoglu L, Azap Ö, Can F, Akalın H, Timurkaynak F. Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality. J Hosp Infect 2016; 94:381-385. [PMID: 27717604 DOI: 10.1016/j.jhin.2016.08.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 08/02/2016] [Indexed: 12/28/2022]
Abstract
This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.
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Affiliation(s)
- Ö Ergönül
- Koç University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey.
| | - M Aydin
- Başkent University School of Medicine, Istanbul Hospital, Infectious Diseases and Clinical Microbiology Department, Turkey
| | - A Azap
- Ankara University Medical Faculty, Infectious Diseases and Clinical Microbiology Department, Turkey
| | - S Başaran
- Istanbul University Istanbul Medical School, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - S Tekin
- Koç University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - Ş Kaya
- Diyarbakır Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Diyarbakır, Turkey
| | - S Gülsün
- Diyarbakır Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Diyarbakır, Turkey
| | - G Yörük
- Istanbul Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - E Kurşun
- Başkent University School of Medicine, Adana Hospital, Infectious Diseases and Clinical Microbiology Department, Adana, Turkey
| | - A Yeşilkaya
- Başkent University School of Medicine, Ankara Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - F Şimşek
- Okmeydanı Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - E Yılmaz
- Uludağ University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Bursa, Turkey
| | - H Bilgin
- Marmara University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - Ç Hatipoğlu
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - H Cabadak
- Ankara Specialty Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - Y Tezer
- Ankara Specialty Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - T Togan
- Başkent University School of Medicine, Konya Hospital, Infectious Diseases and Clinical Microbiology Department, Konya, Turkey
| | - I Karaoğlan
- Gaziantep University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Gaziantep, Turkey
| | - A İnan
- Haydarpaşa Numune Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - A Engin
- Cumhuriyet University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Sivas, Turkey
| | - H E Alışkan
- Başkent University School of Medicine, Adana Hospital, Infectious Diseases and Clinical Microbiology Department, Adana, Turkey
| | - S Ş Yavuz
- Istanbul University Istanbul Medical School, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - Ş Erdinç
- Ankara Training and Research Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - L Mulazimoglu
- Marmara University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - Ö Azap
- Başkent University School of Medicine, Ankara Hospital, Infectious Diseases and Clinical Microbiology Department, Ankara, Turkey
| | - F Can
- Koç University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Istanbul, Turkey
| | - H Akalın
- Uludağ University School of Medicine, Infectious Diseases and Clinical Microbiology Department, Bursa, Turkey
| | - F Timurkaynak
- Başkent University School of Medicine, Istanbul Hospital, Infectious Diseases and Clinical Microbiology Department, Turkey
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