Tags

Type your tag names separated by a space and hit enter

The association between colonization with carbapenemase-producing enterobacteriaceae and overall ICU mortality: an observational cohort study.
Crit Care Med. 2015 Jun; 43(6):1170-7.CC

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-β-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.

Authors+Show Affiliations

1Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands. 2Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. 3Department of Molecular Microbiology, National Medicines Institute, Warsaw, Poland. 44th Department of Internal Medicine, Athens University Medical School, University General Hospital Attikon, Athens, Greece. 56th Department of Internal Medicine, Hygeia General Hospital, Athens University Medical School, Athens, Greece. 6Infectious Diseases Unit, Laikon General Hospital, University of Athens, Athens, Greece. 7Service de Reanimation Médicale and INSERM U657, Institut Pasteur, APHP GH Henri Mondor, Université Paris Est-Créteil, Creteil, France. 8Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

25882764

Citation

Dautzenberg, Mirjam J D., et al. "The Association Between Colonization With Carbapenemase-producing Enterobacteriaceae and Overall ICU Mortality: an Observational Cohort Study." Critical Care Medicine, vol. 43, no. 6, 2015, pp. 1170-7.
Dautzenberg MJ, Wekesa AN, Gniadkowski M, et al. The association between colonization with carbapenemase-producing enterobacteriaceae and overall ICU mortality: an observational cohort study. Crit Care Med. 2015;43(6):1170-7.
Dautzenberg, M. J., Wekesa, A. N., Gniadkowski, M., Antoniadou, A., Giamarellou, H., Petrikkos, G. L., Skiada, A., Brun-Buisson, C., Bonten, M. J., & Derde, L. P. (2015). The association between colonization with carbapenemase-producing enterobacteriaceae and overall ICU mortality: an observational cohort study. Critical Care Medicine, 43(6), 1170-7. https://doi.org/10.1097/CCM.0000000000001028
Dautzenberg MJ, et al. The Association Between Colonization With Carbapenemase-producing Enterobacteriaceae and Overall ICU Mortality: an Observational Cohort Study. Crit Care Med. 2015;43(6):1170-7. PubMed PMID: 25882764.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association between colonization with carbapenemase-producing enterobacteriaceae and overall ICU mortality: an observational cohort study. AU - Dautzenberg,Mirjam J D, AU - Wekesa,Ann N, AU - Gniadkowski,Marek, AU - Antoniadou,Anastasia, AU - Giamarellou,Helen, AU - Petrikkos,George L, AU - Skiada,Anna, AU - Brun-Buisson,Christian, AU - Bonten,Marc J M, AU - Derde,Lennie P G, AU - ,, PY - 2015/4/18/entrez PY - 2015/4/18/pubmed PY - 2015/7/28/medline SP - 1170 EP - 7 JF - Critical care medicine JO - Crit. Care Med. VL - 43 IS - 6 N2 - 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-β-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. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/25882764/The_association_between_colonization_with_carbapenemase_producing_enterobacteriaceae_and_overall_ICU_mortality:_an_observational_cohort_study_ L2 - https://dx.doi.org/10.1097/CCM.0000000000001028 DB - PRIME DP - Unbound Medicine ER -