Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill patients

Abstract

The incidence of gram-negative multidrug-resistant (MDR) bacterial pathogens is increasing in hospitals and particularly in the intensive care unit (ICU) setting. The clinical consequences of infections caused by MDR pathogens remain controversial. The purpose of this review is to summarize the available data concerning the impact of these infections on mortality in ICU patients. Twenty-four studies, conducted exclusively in ICU patients, were identified through PubMed search over the years 2000-2015. Bloodstream infection was the only infection examined in eight studies, respiratory infections in four and variable infections in others. Comparative data on the appropriateness of empirical antibiotic treatment were provided by only seven studies. In ten studies the presence of antimicrobial resistance was not associated with increased mortality; on the contrary, in other studies a significant impact of antibiotic resistance on mortality was found, though, sometimes, mediated by inappropriate antimicrobial treatment. Therefore, a direct association between infections due to gram-negative MDR bacteria and mortality in ICU patients cannot be confirmed. Sample size, presence of multiple confounders and other methodological issues may influence the results. These data support the need for further studies to elucidate the real impact of infections caused by resistant bacteria in ICU patients.

Antibiotic resistance rates among bacterial isolates from infected patients of intensive care unit over the period (2011-2016) in Bursa, Turkey

“…Studies have also shown an increasing carbapenem-resistance in P. aeruginosa isolates from ICU-acquired infections [19][20][21]. In our study, there was a significantly decrease in the resistant rates of Pseudomonas spp.…”

Prevalence and Antibiotic Susceptibility among Gram Negative Bacteria Isolated from Intensive Care Units at a Tertiary Care Hospital in Riyadh, Saudi Arabia

“…There is a remarkable increase of multidrug-resistant (MDR) gram-negative bacteria in hospitals and significantly in the intensive care unit (ICU) setting. The clinical outcomes of infections brought about by MDR pathogens as yet dubious 14 . The resistance pattern is most likely noted in ICUs due to the unlimited use of antibiotics in these units compared to the other hospital departments 15 and 70% of these infections were caused by GNB 16 .…”

Surgical Antibiotic Prophylaxis and Risk for Postoperative Antibiotic-Resistant Infections

“…(30–32) This finding is concerning because antibiotic-resistant infections are associated with increased morbidity and mortality, as well as longer and more expensive hospital stays. (9, 33) SAP is commonly used for procedures with relatively low risks for post-operative infection. If SAP is associated with even a slight increase in risk for post-operative antibiotic-resistant infections, this observation would become a significant factor in the risk-benefit equation for use of SAP.…”