Carbapenems and subsequent multiresistant bloodstream infection: does treatment duration matter (original) (raw)
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Erciyes Medical Journal, 2019
This study aims to investigate the effect of carbapenem restriction on the infection rate and antibiotic susceptibility. We divided the study period into two: carbapenem-free period (CFP) and carbapenem-restricted period (CRP). We compared the usage rate of antipseudomonal carbapenem, the incidence of nosocomial infection, invasive device days, the causative microorganisms, and antibiotic susceptibility. The nosocomial infection density was 40.95±19.02 in 1000 patient days in the CFP, and 20.71±4.28 in 1000 patient days in the CRP. We observed no significant difference between the two periods in terms of invasive devices use rates. Anti pseudomonal carbapenem usage rate was 2.73 in CFP and 1.67 in CRP. Of the 40 nosocomial infections due to Acinetobacter baumannii, 27 of them were found in the CFP. Carbapenem restriction policy may contribute to decrease the rate of resistant bacterial infections.
Journal of Chemotherapy, 2019
We conducted a two-phase retrospective study to investigate the impact of a short-term carbapenem restriction on the incidence of non-pseudomonal multidrug-resistant (MDR) Gram-negative bacilli in our intensive care unit (ICU). The first phase of the study (before carbapenem restriction) was conducted between May and July 2016, and the second phase (implementation of carbapenem restriction) between September and November 2016. The incidence of all non-pseudomonal MDR Gram-negative bacilli (extended-spectrum b-lactamase-producing Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae and MDR Acinetobacter baumannii) decreased significantly after carbapenem restriction. Patients positive for non-pseudomonal MDR Gram-negative bacilli before and after carbapenem restriction were comparable in terms of age, weight, Acute Physiology and Chronic Health Evaluation IV score, central venous catheter placement, and vasopressor use. This report suggests that short-term carbapenem restriction for 3 months may be an effective strategy for reducing the incidence of non-pseudomonal MDR Gram-negative bacilli.
Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients
Intensive Care Medicine, 2013
Purpose: Carbapenemresistant (CR) Gram-negative pathogens have increased substantially. This study was performed to identify the risk factors for development of CR Gram-negative bacteremia (GNB) in intensive care unit (ICU) patients. Methods: Prospective study; risk factors for development of CR-GNB were investigated using two groups of case patients: the first group consisted of patients who acquired carbapenem susceptible (CS) GNB and the second group included patients with CR-GNB. Both case groups were compared to a shared control group defined as patients without bacteremia, hospitalized in the ICU during the same period. Results: Eightyfive patients with CR-and 84 patients with CS-GNB were compared to 630 control patients, without bacteremia. Presence of VAP (OR 7.59, 95 % CI 4.54-12.69, p \ 0.001) and additional intravascular devices (OR 3.69, 95 % CI 2.20-6.20, p \ 0.001) were independently associated with CR-GNB. Presence of VAP (OR Keywords Carbapenem-resistance Á Gram-negative bacilli Á Bacteremia Á Blood stream infections Á Critically ill patients
Iranian journal of pharmaceutical research : IJPR, 2013
Development of antibiotic resistance in Intensive Care Units (ICUs) is a worldwide problem. The purpose of this study was to evaluate the effect of an antibiotic stewardship program (ASP) by carbapenems restriction on gram-negative antimicrobial resistance in ICU. The study was designed in a 21 bedded general ICU of a teaching hospital with two wings (one and two) in Tehran, Iran. Carbapenem prescription in ICU1 was restricted to only the culture proven multi-drug-resistant bacteria with the absence of sensitivity to other antimicrobial agents. Carbapenem had to be prescribed by a trained ICU physician with close consultation with infectious disease specialist and the clinical pharmacist posted in ICU. Post-prescription reviews and de-escalations were carried out by the same team on regular basis. Restriction policy was commenced in January 2011 in ICU1. All documented infections and resistance patterns of isolated pathogens were recorded in both ICUs during two periods of 6 months ...
Journal of Medical Microbiology, 2017
Purpose. Acinetobacter baumannii and Pseudomonas aeruginosa provoke serious infections, especially in intensive care unit (ICU) patients. Methodology. The risk factors and predictors of mortality for P. aeruginosa (n=84; 46 carbapenem-resistant) and A. baumannii (n=129; all carbapenem-resistant) bloodstream infections (BSIs) in an ICU were evaluated. Antibiotic susceptibility testing was performed using the agar disk diffusion method according to EUCAST guidelines. The minimum inhibitory concentration was determined by a gradient method (Etest). Multilocus sequence typing (MLST) was performed for P. aeruginosa during the carbapenem-resistant outbreak in 2014. Epidemiological data were collected from the patients' chart reviews. Results/Key findings. Hospitalization during the summer months, prior KPC-producing Klebsiella pneumoniae (KPC-Kp) BSI, and the administration of tigecycline, aminoglycosides and cortisone were independently associated with P. aeruginosa BSIs. MLST revealed the dissemination of clone ST227, including carbapenem-resistant P. aeruginosa strains. Hospitalization during the summer months, prior KPC-Kp BSI, and the administration of antibiotics, carbapenem and cortisone were independently associated with A. baumannii BSIs. The 30-day mortality rate for P. aeruginosa and A. baumannii BSI was 45.2 and 39.5 %, respectively. Sequential organ failure assessment (SOFA) score at onset, septic shock, age, and prior KPC-Kp BSI were significantly associated with P. aeruginosa BSI mortality. The administration of at least one active antibiotic was identified as a predictor of a good prognosis. Septic shock and simplified acute physiology score (SAPS) II at onset were independently associated with A. baumannii BSI mortality. The administration of at least one active antibiotic and colistinvancomycin co-administration were identified as predictors of a good prognosis. Conclusion. KPC-Kp infection predisposes ICU patients to BSI by either A. baumannii or P. aeruginosa. The administration of at least one active antibiotic leads to better survival rates.
Expert Review of Anti-infective Therapy, 2020
Background: Carbapenem-resistant Enterobacteriaceae (CRE) infection is associated with intensive care admissions, morbidity and mortality. Our study aimed to determine the incidence, risk factors and patient outcomes of CRE in the ICU units. Methods: This was a retrospective matched case-control study of patients admitted to ICUs. Patients who have positive cultures of CRE and carbapenem-susceptible Enterobacteriaceae (CSE) were included in the study. Patients were randomly selected from a pool of CSE subjects in a ratio of 1:1 of CRE to CSE as control patients. Results: The infection rate with CRE among all patients admitted to ICUs was 7.6% and the incidence of CRE infection was 5.6 per 1,000 person-day. The risk factors independently associated with CRE infection were: Higher Sequential Organ Failure Assessment (SOFA) and Nutrition Risk in Critically ill (NUTRIC) scores, prolonged ICU length of stay (LOS), previous surgery, dialysis and mechanical ventilation during ICU stay, previous use of aminoglycoside and carbapenems. Conclusion: In this retrospective study the incidence of CRE infection was relatively elevated in patients admitted to ICU. Patients with high SOFA and NUTRIC scores, prolonged ICU LOS, previous surgery, dialysis and mechanical ventilation, prior aminoglycosides and carbapenems use, may have an increased risk of CRE infection.
Bangladesh Journal of Medical Science
Objective: Acinetobacter spp. infection is a challenging problem in intensive care unit (ICU) because of its multi-drug resistant (MDR) in nature to antibiotic therapy including broadspectrum carbapenem group. The aims of the study were to determine the risk factors of mortality and the outcome of carbapenem-resistant Acinetobacter spp. (CRAs) infection in our ICU. Materials and Method: This is a retrospective, cross-sectional study, done in 2 years from January 2008 to December 2009. The list of the patients was obtained from hospital nosocomial infection surveillance unit and ICU infection record. The data of the patients were subsequently reviewed from their respective medical records after approval from university ethics committee and hospital medical record unit. Results and Discussion: A total of 92 patients were reviewed and only 54 were included and analyzed. The prevalence of CRAs over 24 months was 7.3%. Mortality was 50% among the reviewed patients and this contributed 13...
Annals of Clinical Microbiology and Antimicrobials, 2014
Background: The consumption of carbapenems has increased worldwide, together with the increase in resistant gram negative bacilli. Subsequently, the prevalence of carbapenem-resistant Acinetobacter infections has increased rapidly and become a significant problem particularly in intensive care unit patients. The aim of the present study was to evaluate the changes in the prevalence of Acinetobacter infection by restricting the consumption of carbapenems in intensive care unit patients. Methods: This study was conducted between May 1, 2011 and February 28, 2013. The amount of carbapenem consumption and the number of patients with multi-drug resistant Acinetobacter baumannii (MDRAB) isolates during the study period were retrospectively obtained from the records of the patients, who were hospitalized in the intensive care unit. The study period was divided into two periods named as: Carbapenem non-restricted period (CNRP) and carbapenem-restricted period (CRP). During CNRP, no restrictions were made on the use of carbapenems. During CRP, the use of carbapenems was not allowed if there was an alternative to carbapenems. Primary Endpoint: MDRAB infection after ICU admission. The definition of nosocomial infections related to Acinetobacter spp. was based on the criteria of the Center for Disease Control (CDC). The correlation between the amount of carbapenem consumption and the number of infections with MDRAB strains between the two periods were evaluated.