The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study

Abstract

Background In the recent era, antimicrobial resistance has been identified as one of the most important threats to human health worldwide. The rapid emergence of antibiotic-resistant pathogens (ABRP) in the modern intensive care unit (ICU) also represents a “nightmare scenario” with unknown clinical consequences. In the Greek ICU, in particular, gram negative ABRPs are now considered endemic. However, the possible longitudinal impact of ABRPs on long-term outcomes of ICU patients has not yet been determined. Methods In this two-year (January 2014-December 2015) single-centre observational longitudinal study, 351 non-neurocritical ICU patients ≥ 18 year-old were enrolled. Patients’ demographic, clinical and outcome data were prospectively collected. Quality-adjusted life years (QALY) were calculated at 6, 12, 18 and 24 months after ICU admission. Results Fifty-eight patients developed infections due to ABRP (ABRP group), 57 due to non-ABRP (non-ABRP group), and 236 demonstrated no infection (no-infection group) while in ICU. Multiple regression analysis revealed that multiple organ dysfunction syndrome score (OR: 0.676, 95%CI 0.584–0.782; P < 0.001) and continuous renal replacement therapy (OR: 4.453, 95%CI 1.805–10.982; P = 0.001) were the only independent determinants for ABRP infections in ICU. Intra-ICU, 90-day and 2-year mortality was 27.9%, 52.4% and 61.5%, respectively. Compared to the non-ABRP and no-infection group, the ABRP group demonstrated increased intra-ICU, 90-day and 2-year mortality (P ≤ 0.022), worse 2-year survival rates in ICU patients overall and ICU survivor subset (Log-rank test, P ≤ 0.046), and poorer progress over time in 2-year QALY kinetics in ICU population overall, ICU survivor and 2-year survivor subgroups (P ≤ 0.013). ABRP group was further divided into multi-drug and extensively-drug resistant subgroups [MDR (n = 34) / XDR (n = 24), respectively]. Compared to MDR subgroup, the XDR subgroup demonstrated increased ICU, 90-day and 2-year mortality (P ≤ 0.031), but similar 90-day and 2-year QALYs (P ≥ 0.549). ABRP infections overall (HR = 1.778, 95% CI 1.166–2.711; P = 0.008), as well as XDR [HR = 1.889, 95% CI 1.075–3.320; P = 0.027) but not MDR pathogens, were independently associated with 2-year mortality, after adjusting for several covariates of critical illness. Conclusions The present study may suggest a significant association between ABRP (especially XDR) infections in ICU and increased mortality and inability rates for a prolonged period post-discharge that requires further attention in larger-scale studies.

The impact of antibiotic resistance on the rampant spread of infectious diseases in Pakistan: Insights from a narrative review

“…The most obvious difficulty faced on a personal level in the context of increasing ABR is that of a decreasing QOL postinfection. A study conducted on 351 ICU patients showed a significant association between ABR pathogen isolation in subjects and increased post‐discharge mortality and morbidity rates 45 . Although the study is conducted in Greece, one can safely extrapolate the markedly adverse results when the same metrics are applied to an objectively poorer country with a subpar healthcare system, such as Pakistan.…”

“…A study conducted on 351 ICU patients showed a significant association between ABR pathogen isolation in subjects and increased post‐discharge mortality and morbidity rates. 45 Although the study is conducted in Greece, one can safely extrapolate the markedly adverse results when the same metrics are applied to an objectively poorer country with a subpar healthcare system, such as Pakistan. Similar and more prominent associations are found regarding LOS and hospital costs, as with one study conducted in Ghent, Belgium.…”

Cost-Effectiveness of Short Course of Ceftazidime/Avibactam for K. pneumoniae-KPC Bloodstream Infections in Italy

“…Costs estimates are limited by having been obtained by a single center, and could have limited representativeness in countries without single-payer health systems. QALY estimates were obtained from a single Greek study [ 28 ], however, the clinical characteristics of included patients, as well as the broader epidemiological context [ 27 ], can be considered comparable to our setting.…”

Characterization of β-Lactamase Genes among Multidrug- and Extensively Drug-Resistant Acinetobacter and Enterobacteriaceae Species Causing Infections in Critically Ill Patient

“…One of the biggest risks for critically ill patients in intensive care units (ICUs) is multidrug resistant organisms (MDROs), which restricts treatment options, leads to poor clinical outcomes, and drives up healthcare costs. Gram-negative (GN) bacteria that are extensively drug resistant (XDR) and multi-drug resistant (MDR) are currently endemic 1 .…”