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The rising influx of multidrug-resistant gram-negative bacilli into a tertiary care hospital.
Clin Infect Dis. 2005 Jun 15; 40(12):1792-8.CI

Abstract

BACKGROUND

The prevalence of multidrug resistance (MDR) among gram-negative bacilli is rapidly increasing. Quantification of the prevalence and the common antimicrobial coresistance patterns of MDR gram-negative bacilli (MDR-GNB) isolates recovered from patients at hospital admission, as well as identification of patients with a high risk of harboring MDR-GNB, would have important implications for patient care.

METHODS

Over a 6-year period, patients who harbored MDR-GNB (i.e., patients who had MDR-GNB isolates recovered from clinical cultures within the first 48 h after hospital admission) were identified. "MDR-GNB isolates" were defined as Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, and Klebsiella species isolates with resistance to at least 3 antimicrobial groups. A case-control study was performed to determine the independent risk factors for harboring MDR-GNB at hospital admission.

RESULTS

Between 1998 and 2003, the prevalence of MDR-GNB isolates recovered from patients at hospital admission increased significantly for all isolate species (P < .001), with the exception of P. aeruginosa (P = .09). Of 464 MDR-GNB isolates, 12%, 35%, and 53% of isolates were coresistant to 5, 4, and 3 antimicrobial groups, respectively. Multivariable analysis identified age > or = 65 years (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.1-7.4; P < .04), prior exposure to antibiotics for > or = 14 days (OR, 8.7; 95% CI, 2.5 -30; P < .001), and prior residence in a long-term care facility (OR, 3.5; 95% CI, 1.3-9.4; P < .01) as independent risk factors for harboring MDR-GNB at hospital admission.

CONCLUSION

A substantial number of patients harbor MDR-GNB at hospital admission. Identification of common coresistance patterns among MDR-GNB isolates may assist in the selection of empirical antimicrobial therapy for patients with a high risk of harboring MDR-GNB.

Authors+Show Affiliations

Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA. apopvic@bidmc.harvard.eduNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

15909268

Citation

Pop-Vicas, Aurora E., and Erika M C. D'Agata. "The Rising Influx of Multidrug-resistant Gram-negative Bacilli Into a Tertiary Care Hospital." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 40, no. 12, 2005, pp. 1792-8.
Pop-Vicas AE, D'Agata EM. The rising influx of multidrug-resistant gram-negative bacilli into a tertiary care hospital. Clin Infect Dis. 2005;40(12):1792-8.
Pop-Vicas, A. E., & D'Agata, E. M. (2005). The rising influx of multidrug-resistant gram-negative bacilli into a tertiary care hospital. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 40(12), 1792-8.
Pop-Vicas AE, D'Agata EM. The Rising Influx of Multidrug-resistant Gram-negative Bacilli Into a Tertiary Care Hospital. Clin Infect Dis. 2005 Jun 15;40(12):1792-8. PubMed PMID: 15909268.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The rising influx of multidrug-resistant gram-negative bacilli into a tertiary care hospital. AU - Pop-Vicas,Aurora E, AU - D'Agata,Erika M C, Y1 - 2005/05/06/ PY - 2004/12/08/received PY - 2005/02/08/accepted PY - 2005/5/24/pubmed PY - 2006/9/19/medline PY - 2005/5/24/entrez SP - 1792 EP - 8 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 40 IS - 12 N2 - BACKGROUND: The prevalence of multidrug resistance (MDR) among gram-negative bacilli is rapidly increasing. Quantification of the prevalence and the common antimicrobial coresistance patterns of MDR gram-negative bacilli (MDR-GNB) isolates recovered from patients at hospital admission, as well as identification of patients with a high risk of harboring MDR-GNB, would have important implications for patient care. METHODS: Over a 6-year period, patients who harbored MDR-GNB (i.e., patients who had MDR-GNB isolates recovered from clinical cultures within the first 48 h after hospital admission) were identified. "MDR-GNB isolates" were defined as Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, and Klebsiella species isolates with resistance to at least 3 antimicrobial groups. A case-control study was performed to determine the independent risk factors for harboring MDR-GNB at hospital admission. RESULTS: Between 1998 and 2003, the prevalence of MDR-GNB isolates recovered from patients at hospital admission increased significantly for all isolate species (P < .001), with the exception of P. aeruginosa (P = .09). Of 464 MDR-GNB isolates, 12%, 35%, and 53% of isolates were coresistant to 5, 4, and 3 antimicrobial groups, respectively. Multivariable analysis identified age > or = 65 years (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.1-7.4; P < .04), prior exposure to antibiotics for > or = 14 days (OR, 8.7; 95% CI, 2.5 -30; P < .001), and prior residence in a long-term care facility (OR, 3.5; 95% CI, 1.3-9.4; P < .01) as independent risk factors for harboring MDR-GNB at hospital admission. CONCLUSION: A substantial number of patients harbor MDR-GNB at hospital admission. Identification of common coresistance patterns among MDR-GNB isolates may assist in the selection of empirical antimicrobial therapy for patients with a high risk of harboring MDR-GNB. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/15909268/The_rising_influx_of_multidrug_resistant_gram_negative_bacilli_into_a_tertiary_care_hospital_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/430314 DB - PRIME DP - Unbound Medicine ER -