Risk factors and mortality associated with multi-drug-resistant Gram-negative bacterial infection in adult patients following abdominal surgery

Lin, Tsan‐Shiun; Chang, Po-Hsun; Chen, I‐Ling; Lai, Wei-Hung; Chen, Ying-Ju; Li, Weifeng; Lee, Ing-Kit; Wang, Chih-Chi

doi:10.1016/j.jhin.2021.09.021

Cited by 26 publications

(24 citation statements)

References 43 publications

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“…Recent studies pointed out that renal insufficiency is one of the main high-risk factors for associated multi-drug resistant bacterial infections, and the distribution of pathogenic bacteria may not be identical between patients with hemorrhagic infection with renal insufficiency and non-renal patients. 15 , 16 At present, there is a lack of clinical guidelines and expert consensus on the treatment of patients with septicemic bloodstream infection with renal insufficiency, and the relevant literature is scarce, which is therefore not conducive to the empirical use of anti-infective therapy and the selection of antimicrobial drugs in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Distribution and Drug Resistance of Pathogenic Bacteria and Prognosis in Patients with Septicemia Bloodstream Infection with Renal Insufficiency

Pan¹,

Peng²,

Yu³

et al. 2022

IDR

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Objective The aim of this study was to investigate the distribution and drug resistance of pathogenic bacteria and the prognosis of patients with sepsis bloodstream infection with renal insufficiency. Methods One hundred and twelve patients with septicemic bloodstream infection with renal insufficiency and 112 patients with septic bloodstream infection without renal insufficiency were selected as study group and control group, respectively. We compare the distribution of pathogenic bacteria, analyze the drug resistance of major bacteria, and compare the efficacy, the incidence of septic shock, duration of mechanical ventilation, hospitalization time, and duration of antimicrobial drug administration between the two groups. Results A total of 140 pathogenic strains were isolated from blood cultures in the study group, and 136 strains were isolated from blood cultures in the control group. The sepsis bloodstream infection was mainly caused by Gram-negative bacteria, accounting for 59.42% (164/276). Among the gram-negative bacteria, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa , and Acinetobacter baumannii had higher resistance rates to levofloxacin, ceftazidime, piperacillin sodium tazobactam, and amikacin. Among the gram-positive bacteria, Streptococcus pneumoniae, Enterococcus , and Staphylococcus aureus had high resistance rates to clindamycin, cefazolin, penicillin G, gentamicin, azithromycin, and levofloxacin. The rate of extended spectrum β-lactamase (ESBLs)-producing enterobacteria and multi-drug resistant Pseudomonas aeruginosa (MDR-PA) infection was significantly higher in the study group than in the control group; there was no difference in multi-drug resistant Acinetobacter baumannii (MDR-AB), vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) between the two groups. The duration of hospitalization and the duration of antimicrobial drug administration were longer in the study group than in the control group. Conclusion The pathogenic bacteria in patients with sepsis bloodstream infection with renal insufficiency are mainly Gram-negative bacteria, are more difficult to be cured, have a longer course of treatment, and need to use antibacterial drugs for a long time.

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Section: Discussionmentioning

confidence: 99%

Distribution and Drug Resistance of Pathogenic Bacteria and Prognosis in Patients with Septicemia Bloodstream Infection with Renal Insufficiency

Pan¹,

Peng²,

Yu³

et al. 2022

IDR

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“…Prior infection with MDR, hospitalization within the last few months, number of admissions, interventions during admissions, transfer to ICU, and being a kidney transplant patient all increase the risk for MDR. [26][27][28][29] Different stages of chronic kidney disease (CKD), as shown by Guobin et al, will increase the risk for MDR. 30 Lastly, emerging resistant genes in bacteria contributed to increased incidence of MDR.…”

Section: Discussionmentioning

confidence: 99%

Acute Kidney Injury Among Patients with Multi-Drug Resistant Infection: A Study from Jordan

Oweis¹,

Zeyad²,

Alshelleh³

et al. 2022

JMDH

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Background: Acute kidney injury (AKI) is a well-known complication for hospitalized patients. Sepsis and various infections play a significant role in increasing the incidence of AKI. The present study evaluated the risk for Multidrug-resistant (MDR) infections and its effect on the incidence of AKI, hospitalization, need for dialysis, and mortality. Methods: In a retrospective study design, data were collected from all adult patients with a positive multi-drug resistant culture who were admitted to King Abdullah University Hospital (KAUH). Records of 436 patients were reviewed between January 2017 -December 2018 with at least one year of follow-up. Results: The mean age was 57.3 years (SD± 23.1), and 58.5% were males. The most common source of positive cultures was sputum, with 50% positive cultures. The incidence of AKI was 59.2%. The most isolated microorganism was Acinetobacter baumannii (76.8%), followed by Pseudomonas aeruginosa (14.9%).On multivariate analysis, age (OR 1.1, 95% CI 1.1-1.2, P=0.001), HTN (OR 1.8, 95% CI 1.0-3.3, P=0.02), DM (OR 1.1, 95% CI 0.6-1.9, P=0.69) and the use of Foley catheter on chronic bases (OR 4.3, 95% CI 2.6-6.8, P<0.0001) were strong predictors of AKI. Among patients with AKI, 74.4% died compared to 44.4% among non-AKI patients (p<0.001). Conclusion:In patients with MDR, AKI incidence, hospitalization, and mortality were high. Early detection and addressing the problem may decrease bad outcomes, and health education for reducing antibiotic abuse is needed to lower MDR.

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“…Recently, Lin et al 31 . examined the predisposing factors for infection by MDR Gram-negative bacilli amongst patients who endured abdominal surgery.…”

Section: Discussionmentioning

confidence: 99%

Multidrug-Resistant Gram-Negative ESKAPE Pathogens from a Tertiary-Care Hospital: Prevalence and Risk Factors

El-Kady

Karoma

Atrouni

2022

Egyptian Journal of Medical Microbiology

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Antibiotic-resistant ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are commonly implicated in health-care associated infections (HAIs). Objectives: The purpose of this study is to assess the antimicrobial susceptibility profile of Gram-negative ESKAPE pathogens, with prime emphasis on the prevalence and risk factors for infections by multidrug-resistant (MDR) strains. Methodology: In this retrospective cohort study, we reviewed the electronic medical and laboratory records of our tertiary health-care facility throughout the period from January 2019 to December 2020. Adult patients identified with infections by any of the Gram-negative ESKAPE bacteria were eligible for our study. The risk factors associated with acquisition of MDR organisms were analyzed using univariate and multivariate models. Results: During the period of interest, a total of 614 Gram-negative ESKAPE isolates were identified, of which 121 were found to be MDR (19.7%). A. baumannii was the leading MDR organism (43.1%), whereas MDR P. aeruginosa was the least common (10.7%). The independent risk factors associated with acquisition of MDR infections included long hospital stays (P < 0.0001), undergoing surgical procedures (P= 0.001), ischemic heart disease (P= 0.005), mechanical ventilation (P= 0.005), and presence of indwelling urinary catheter (P= 0.03). Conclusions: Infections with MDR Gram-negative ESKAPE organisms have an alarming magnitude in our institution. Continued vigilance by the involved health-care workers, stringent compliance to the infection control guidelines, and effective implementation of the antimicrobial stewardship programs are critical measures to decrease the burden of this health problem.

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Risk factors and mortality associated with multi-drug-resistant Gram-negative bacterial infection in adult patients following abdominal surgery

Cited by 26 publications

References 43 publications

Distribution and Drug Resistance of Pathogenic Bacteria and Prognosis in Patients with Septicemia Bloodstream Infection with Renal Insufficiency

Distribution and Drug Resistance of Pathogenic Bacteria and Prognosis in Patients with Septicemia Bloodstream Infection with Renal Insufficiency

Acute Kidney Injury Among Patients with Multi-Drug Resistant Infection: A Study from Jordan

Multidrug-Resistant Gram-Negative ESKAPE Pathogens from a Tertiary-Care Hospital: Prevalence and Risk Factors

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