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Determinants and impact of multidrug antibiotic resistance in pathogens causing ventilator-associated-pneumonia

Pieter Depuydt UGent, Dominique Vandijck UGent, Maarten Bekaert, Johan Decruyenaere UGent, Stijn Blot UGent, Dirk Vogelaers UGent and Dominique Benoit UGent (2008) Critical Care. 12(6).
abstract
Introduction The idea that multidrug resistance (MDR) to antibiotics in pathogens causing ventilator-associated pneumonia (VAP) is an independent risk factor for adverse outcome is still debated. We aimed to identify the determinants of MDR versus non-MDR microbial aetiology in VAP and assessed whether MDR versus non-MDR VAP was independently associated with increased 30-day mortality. Methods We performed a retrospective analysis of a prospectively registered cohort of adult patients with microbiologically confirmed VAP, diagnosed at a university hospital intensive care unit during a three-year period. Determinants of MDR as compared with non-MDR microbial aetiology and impact of MDR versus non-MDR aetiology on mortality were investigated using multivariate logistic and competing risk regression analysis. Results MDR pathogens were involved in 52 of 192 episodes of VAP (27%): methicillin-resistant Staphylococcus aureus in 12 (6%), extended-spectrum beta-lactamase producing Enterobacteriaceae in 28 (15%), MDR Pseudomonas aeruginosa and other non-fermenting pathogens in 12 (6%). Multivariable logistic regression identified the Charlson index of comorbidity (odds ratio (OR) = 1.38, 95% confidence interval (CI) = 1.08 to 1.75, p = 0.01) and previous exposure to more than two different antibiotic classes (OR = 5.11, 95% CI = 1.38 to 18.89, p = 0.01) as predictors of MDR aetiology. Thirty-day mortality after VAP diagnosis caused by MDR versus non-MDR was 37% and 20% (p = 0.02), respectively. A multivariate competing risk regression analysis showed that renal replacement therapy before VAP (standardised hazard ratio (SHR) = 2.69, 95% CI = 1.47 to 4.94, p = 0.01), the Charlson index of comorbidity (SHR = 1.21, 95% CI = 1.03 to 1.41, p = 0.03) and septic shock on admission to the intensive care unit (SHR = 1.86, 95% CI = 1.03 to 3.35, p = 0.03), but not MDR aetiology of VAP, were independent predictors of mortality. Conclusions The risk of MDR pathogens causing VAP was mainly determined by comorbidity and prior exposure to more than two antibiotics. The increased mortality of VAP caused by MDR as compared with non-MDR pathogens was explained by more severe comorbidity and organ failure before VAP.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
journal title
Critical Care
Crit. Care
volume
12
issue
6
pages
R142 -
publisher
BIOMED CENTRAL LTD, CURRENT SCIENCE GROUP,
place of publication
LONDON W1T 4LB, ENGLAND
Web of Science type
Article
Web of Science id
000263949200009
JCR category
CRITICAL CARE MEDICINE
JCR impact factor
4.553 (2008)
JCR rank
4/21 (2008)
JCR quartile
1 (2008)
ISSN
1466-609X
DOI
10.1186/cc7119
language
English
UGent publication?
yes
classification
A1
id
527742
handle
http://hdl.handle.net/1854/LU-527742
date created
2009-03-23 10:14:37
date last changed
2017-01-02 09:56:00
@article{527742,
  abstract     = {Introduction The idea that multidrug resistance (MDR) to antibiotics in pathogens causing ventilator-associated pneumonia (VAP) is an independent risk factor for adverse outcome is still debated. We aimed to identify the determinants of MDR versus non-MDR microbial aetiology in VAP and assessed whether MDR versus non-MDR VAP was independently associated with increased 30-day mortality.
Methods We performed a retrospective analysis of a prospectively registered cohort of adult patients with microbiologically confirmed VAP, diagnosed at a university hospital intensive care unit during a three-year period. Determinants of MDR as compared with non-MDR microbial aetiology and impact of MDR versus non-MDR aetiology on mortality were investigated using multivariate logistic and competing risk regression analysis.

Results MDR pathogens were involved in 52 of 192 episodes of VAP (27\%): methicillin-resistant Staphylococcus aureus in 12 (6\%), extended-spectrum beta-lactamase producing Enterobacteriaceae in 28 (15\%), MDR Pseudomonas aeruginosa and other non-fermenting pathogens in 12 (6\%). Multivariable logistic regression identified the Charlson index of comorbidity (odds ratio (OR) = 1.38, 95\% confidence interval (CI) = 1.08 to 1.75, p = 0.01) and previous exposure to more than two different antibiotic classes (OR = 5.11, 95\% CI = 1.38 to 18.89, p = 0.01) as predictors of MDR aetiology. Thirty-day mortality after VAP diagnosis caused by MDR versus non-MDR was 37\% and 20\% (p = 0.02), respectively. A multivariate competing risk regression analysis showed that renal replacement therapy before VAP (standardised hazard ratio (SHR) = 2.69, 95\% CI = 1.47 to 4.94, p = 0.01), the Charlson index of comorbidity (SHR = 1.21, 95\% CI = 1.03 to 1.41, p = 0.03) and septic shock on admission to the intensive care unit (SHR = 1.86, 95\% CI = 1.03 to 3.35, p = 0.03), but not MDR aetiology of VAP, were independent predictors of mortality.

Conclusions The risk of MDR pathogens causing VAP was mainly determined by comorbidity and prior exposure to more than two antibiotics. The increased mortality of VAP caused by MDR as compared with non-MDR pathogens was explained by more severe comorbidity and organ failure before VAP.},
  author       = {Depuydt, Pieter and Vandijck, Dominique and Bekaert, Maarten and Decruyenaere, Johan and Blot, Stijn and Vogelaers, Dirk and Benoit, Dominique},
  issn         = {1466-609X},
  journal      = {Critical Care},
  language     = {eng},
  number       = {6},
  publisher    = {BIOMED CENTRAL LTD, CURRENT SCIENCE GROUP,},
  title        = {Determinants and impact of multidrug antibiotic resistance in pathogens causing ventilator-associated-pneumonia},
  url          = {http://dx.doi.org/10.1186/cc7119},
  volume       = {12},
  year         = {2008},
}

Chicago
Depuydt, Pieter, Dominique Vandijck, Maarten Bekaert, Johan Decruyenaere, Stijn Blot, Dirk Vogelaers, and Dominique Benoit. 2008. “Determinants and Impact of Multidrug Antibiotic Resistance in Pathogens Causing Ventilator-associated-pneumonia.” Critical Care 12 (6): R142.
APA
Depuydt, Pieter, Vandijck, D., Bekaert, M., Decruyenaere, J., Blot, S., Vogelaers, D., & Benoit, D. (2008). Determinants and impact of multidrug antibiotic resistance in pathogens causing ventilator-associated-pneumonia. Critical Care, 12(6), R142.
Vancouver
1.
Depuydt P, Vandijck D, Bekaert M, Decruyenaere J, Blot S, Vogelaers D, et al. Determinants and impact of multidrug antibiotic resistance in pathogens causing ventilator-associated-pneumonia. Critical Care. LONDON W1T 4LB, ENGLAND: BIOMED CENTRAL LTD, CURRENT SCIENCE GROUP,; 2008;12(6):R142.
MLA
Depuydt, Pieter, Dominique Vandijck, Maarten Bekaert, et al. “Determinants and Impact of Multidrug Antibiotic Resistance in Pathogens Causing Ventilator-associated-pneumonia.” Critical Care 12.6 (2008): R142. Print.