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Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
11:17

Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses

Published on: August 30, 2018

Impact of antibiotic-resistant Gram-negative bacilli infections on outcome in hospitalized patients

Daniel P Raymond1, Shawn J Pelletier, Traves D Crabtree

  • 1Surgical Infectious Disease Research Laboratory, Department of Surgery, University of Virginia, Charlottesville, VA, USA.

Critical Care Medicine
|April 12, 2003
PubMed
Abstract

Insights

Antibiotic-resistant Gram-negative rod (GNR) infections are linked to longer hospital stays and higher mortality. However, resistance itself may not directly increase mortality, suggesting infection control for specific bacterial species is key.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Hospital Epidemiology

Background:

  • The independent impact of antibiotic-resistant Gram-negative rod (GNR) infections on patient mortality is not well-established.
  • Understanding risk factors for resistant GNR infections and their associated mortality is crucial for effective patient management.

Purpose of the Study:

  • To determine the risk factors associated with antibiotic-resistant GNR infections.
  • To quantify the excess mortality attributable to resistant GNR infections compared to nonresistant GNR infections.

Main Methods:

  • A prospective cohort study was conducted in inpatient surgical wards of a university hospital.
  • Patients (n=924) diagnosed with Gram-negative rod (GNR) infection between December 1996 and September 2000 were analyzed.
  • Characteristics and outcomes were compared between resistant GNR (rGNR) and nonresistant GNR infections using univariate and logistic regression.

Main Results:

  • Resistant GNR infections (n=203) were associated with higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores, comorbidities, and specific infection types (pneumonia, catheter).
  • Logistic regression indicated rGNR infection was an independent predictor of mortality (OR, 2.23; 95% CI, 1.35-3.67).
  • However, matched analyses controlling for organism, age, APACHE II score, and infection site revealed no significant difference in mortality between resistant and nonresistant GNR infections (23.6% vs. 29.2%, p=.35).

Conclusions:

  • While rGNR infections are associated with prolonged hospital stays and initially appear to independently predict mortality, this association may be confounded by the selection of inherently more virulent bacterial species.
  • Antibiotic resistance itself may not be the primary driver of increased mortality.
  • Infection control strategies focusing on limiting the dissemination of specific bacterial species, rather than solely targeting antibiotic resistance, may be more effective in reducing mortality.

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