Mandakini Pawar1, Yatin Mehta2, Apoorva Purohit1, Naresh Trehan2, Rosenthal Victor Daniel3
1 Escorts Heart Institute and Research Centre, New Delhi, India
2 Indraprastha Apollo Hospital, New Delhi, India
3 Medical College of Buenos Aires, Argentina
The objective of this study was to compare the risk factors and outcome of patients with preexisting resistant gram-negative bacilli (GNB) with those who develop sensitive GNB in the cardiac intensive care unit (ICU). Of the 3161 patients ( n = 3,161) admitted to the ICU during the study period, 130 (4.11%) developed health care-associated infections (HAIs) with GNB and were included in the cohort study. Pseudomonas aeruginosa (37.8%) was the most common organism isolated followed by Klebsiella species (24.2%), E. coli (22.0%), Enterobacter species (6.1%), Stenotrophomonas maltophilia (5.7%), Acinetobacter species (1.3%), Serratia marcescens (0.8%), Weeksella virosa (0.4%) and Burkholderia cepacia (0.4%). Univariate analysis revealed that the following variables were significantly associated with the antibiotic-resistant GNB: females ( P = 0.018), re-exploration ( P = 0.004), valve surgery ( P = 0.003), duration of central venous catheter ( P < 0.001), duration of mechanical ventilation ( P < 0.001), duration of intra-aortic balloon counter-pulsation ( P = 0.018), duration of urinary catheter ( P < 0.001), total number of antibiotic exposures prior to the development of resistance ( P < 0.001), duration of antibiotic use prior to the development of resistance ( P = 0.014), acute physiology and age chronic health evaluation score (APACHE II), receipt of anti-pseudomonal penicillins (piperacillin-tazobactam) ( P = 0.002) and carbapenems ( P < 0.001). On multivariate analysis, valve surgery (adjusted OR = 2.033; 95% CI = 1.052-3.928; P = 0.035), duration of mechanical ventilation (adjusted OR = 1.265; 95% CI = 1.055-1.517; P = 0.011) and total number of antibiotic exposure prior to the development of resistance (adjusted OR = 1.381; 95% CI = 1.030-1.853; P = 0.031) were identified as independent risk factors for HAIs in resistant GNB. The mortality rate in patients with resistant GNB was significantly higher than those with sensitive GNB (13.9% vs. 1.8%; P = 0.03). HAI with resistant GNB, in ICU following cardiac surgery, are independently associated with the following variables: valve surgeries, duration of mechanical ventilation and prior exposure to antibiotics. The mortality rate is significantly higher among patients with resistant GNB.
Department of Anesthesiology and Critical Care, Indraprastha Apollo Hospital, New Delhi
Source of Support: None, Conflict of Interest: None
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