Publication
Title
The association between colonization with carbapenemase-producing Enterobacteriaceae and overall ICU mortality : an observational cohort study
Author
Institution/Organisation
Mastering hOSpital Antimicrobial Resistance in Europe Work Package 3 Study Team
Abstract
Objectives: Infections caused by carbapenemase-producing Enterobacteriaceae are increasing worldwide, especially in ICUs, and have been associated with high mortality rates. However, unequivocally demonstrating causality of such infections to death is difficult in critically ill patients because of potential confounding and competing events. Here, we quantified the effects of carbapenemase-producing Enterobacteriaceae carriage on patient outcome in two Greek ICUs with carbapenemase-producing Enterobacteriaceae endemicity. Design: Observational cohort study. Setting: Two ICUs with carbapenemase-producing Enterobacteriaceae endemicity. Patients: Patients admitted to the ICU with an expected length of ICU stay of at least 3 days were included. Interventions: None. Measurements and Main Results: Carbapenemase-producing Enterobacteriaceae colonization was established through screening in perineum swabs obtained at admission and twice weekly and inoculated on chromogenic plates. Detection of carbapenemases was performed phenotypically, with confirmation by polymerase chain reaction. Risk factors for ICU mortality were evaluated using cause-specific hazard ratios and subdistribution hazard ratios, with carbapenemase-producing Enterobacteriaceae colonization as time-varying covariate. One thousand seven patients were included, 36 (3.6%) were colonized at admission, and 96 (9.5%) acquired carbapenemase-producing Enterobacteriaceae colonization during ICU stay, and 301 (29.9%) died in ICU. Of 132 carbapenemase-producing Enterobacteriaceae isolates, 125 (94.7%) were Klebsiella pneumoniae and 74 harbored K. pneumoniae carbapenemase (56.1%), 54 metallo-[beta]-lactamase (40.9%), and four both (3.0%). Carbapenemase-producing Enterobacteriaceae colonization was associated with a statistically significant increase of the subdistribution hazard ratio for ICU mortality (subdistribution hazard ratio = 1.79; 95% CI, 1.31-2.43), not explained by an increased daily hazard of dying (cause-specific hazard ratio for death = 1.02; 95% CI, 0.74-1.41), but by an increased length of stay (cause-specific hazard ratio for discharge alive = 0.73; 95% CI, 0.51-0.94). Other risk factors in the subdistribution hazard model were Acute Physiology and Chronic Health Evaluation II score (subdistribution hazard ratio = 1.13; 95% CI, 1.11-1.15), female gender (subdistribution hazard ratio = 1.29; 95% CI, 1.02-1.62), presence of solid tumor (subdistribution hazard ratio = 1.54; 95% CI, 1.15-2.06), hematopoietic malignancy (subdistribution hazard ratio = 1.61; 95% CI, 1.04-2.51), and immunodeficiency (subdistribution hazard ratio = 1.59; 95% CI, 1.11-2.27). Conclusions: Patients colonized with carbapenemase-producing Enterobacteriaceae have on average a 1.79 times higher hazard of dying in ICU than noncolonized patients, primarily because of an increased length of stay.
Language
English
Source (journal)
Critical care medicine / Society of Critical Care Medicine [Anaheim, Calif.] - Baltimore, Md, 1973, currens
Publication
Baltimore, Md : 2015
ISSN
0090-3493
1530-0293 [online]
DOI
10.1097/CCM.0000000000001028
Volume/pages
43 :6 (2015) , p. 1170-1177
ISI
000354720300025
Full text (Publisher's DOI)
Full text (open access)
UAntwerpen
Faculty/Department
Research group
Project info
The role of bacterial biofilms as a major cause of therapeutic failure in intensive care units (ICU): an in vitro and in vivo study of 'biofilm' virulence factors.
Publication type
Subject
External links
Web of Science
Record
Identifier
Creation 19.08.2015
Last edited 06.02.2023
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