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J Infect. 2015 Mar;70(3):213-22. doi: 10.1016/j.jinf.2014.10.004. Epub 2014 Oct 27.

Resistance patterns and outcomes in intensive care unit (ICU)-acquired pneumonia. Validation of European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms.

Author information

1
St. James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland; Critical Care Center, Corporacion Sanitaria Parc Taulí, CIBER Enfermedades Respiratorias, Parc Tauli, University Institute, Sabadell, Spain.
2
Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain. Electronic address: ATORRES@clinic.ub.es.
3
Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain.
4
Intensive Care Medicine, Hospital Universitari i Politècnic la Fe, CIBER Enfermedades Respiratorias, Valencia, Spain.
5
Critical Care Center, Corporacion Sanitaria Parc Taulí, CIBER Enfermedades Respiratorias, Parc Tauli, University Institute, Sabadell, Spain.

Abstract

INTRODUCTION:

Bacterial resistance has become a major public health problem.

OBJECTIVE:

To validate the definition of multidrug-resistant organisms (MDRO) based on the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification.

MATERIAL:

Prospective, observational study in six medical and surgical Intensive-Care-Units (ICU) of a University hospital.

RESULTS:

Three-hundred-and-forty-three patients with ICU-acquired pneumonia (ICUAP) were prospectively enrolled, 140 patients had no microbiological confirmation (41%), 82 patients (24%) developed ICUAP for non-MDRO, whereas 121 (35%) were MDROs. Non-MDRO, MDRO and no microbiological confirmation patients did not present either a significant different previous antibiotic use (p 0.18) or previous hospital admission (p 0.17). Appropriate antibiotic therapy was associated with better ICU survival (105 [92.9%] vs. 74 [82.2%]; p = 0.03). An adjusted multivariate regression logistic analysis identified that only MDRO had a higher ICU-mortality than non-MDRO and no microbiological confirmation patients (OR 2.89; p < 0.05; 95% CI for Exp [β]. 1.02-8.21); Patients with MDRO ICUAP remained in ICU for a longer period than MDRO and no microbiological confirmation respectively (p < 0.01) however no microbiological confirmation patients had more often antibiotic consumption than culture positive ones.

CONCLUSIONS:

Patients who developed ICUAP due to MDRO showed a higher ICU-mortality than non-MDRO ones and use of ICU resources. No microbiological confirmation patients had more often antibiotic consumption than culture positive patients. Risk factors for MDRO may be important for the selection of initial antimicrobial therapy, in addition to local epidemiology.

KEYWORDS:

Appropriate antibiotic treatment; Intensive care; MDR; MDROs; Pneumonia; Sepsis; VAP

PMID:
25445887
DOI:
10.1016/j.jinf.2014.10.004
[Indexed for MEDLINE]

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