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Published on: August 30, 2018
Association between infections caused by multidrug-resistant gram-negative bacteria and mortality in critically ill
Elisabeth Paramythiotou1, Christina Routsi1
1Elisabeth Paramythiotou, Second Department of Critical Care, Medical School, University of Athens, Attikon University Hospital, 12462 Athens, Greece.
Abstract:
The incidence of gram-negative multidrug-resistant (MDR) bacterial pathogens is increasing in hospitals and particularly in the intensive care unit (ICU) setting. The clinical consequences of infections caused by MDR pathogens remain controversial. The purpose of this review is to summarize the available data concerning the impact of these infections on mortality in ICU patients. Twenty-four studies, conducted exclusively in ICU patients, were identified through PubMed search over the years 2000-2015. Bloodstream infection was the only infection examined in eight studies, respiratory infections in four and variable infections in others. Comparative data on the appropriateness of empirical antibiotic treatment were provided by only seven studies. In ten studies the presence of antimicrobial resistance was not associated with increased mortality; on the contrary, in other studies a significant impact of antibiotic resistance on mortality was found, though, sometimes, mediated by inappropriate antimicrobial treatment. Therefore, a direct association between infections due to gram-negative MDR bacteria and mortality in ICU patients cannot be confirmed. Sample size, presence of multiple confounders and other methodological issues may influence the results. These data support the need for further studies to elucidate the real impact of infections caused by resistant bacteria in ICU patients.
Insights
The impact of multidrug-resistant (MDR) gram-negative bacterial infections on intensive care unit (ICU) patient mortality remains unclear. While some studies link MDR infections to increased deaths, others show no direct association, highlighting the need for further research.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Bacteriology
Background:
- Rising incidence of gram-negative multidrug-resistant (MDR) bacterial pathogens in hospital and intensive care unit (ICU) settings.
- Clinical consequences and impact of MDR infections on patient mortality are debated.
- Need for a comprehensive review of existing data on MDR infections in ICU patients.
Purpose of the Study:
- To summarize current data on the impact of gram-negative MDR bacterial infections on mortality in ICU patients.
- To critically evaluate the association between antimicrobial resistance and patient outcomes in the ICU.
- To identify gaps in knowledge and methodological limitations in existing studies.
Main Methods:
- Systematic review of 24 studies published between 2000 and 2015, identified via PubMed search.
- Studies focused exclusively on ICU patients with gram-negative bacterial infections.
- Analysis included various infection types (bloodstream, respiratory, etc.) and data on antibiotic treatment appropriateness.
Main Results:
- Ten studies found no association between antimicrobial resistance and increased mortality.
- Other studies indicated a significant impact of antibiotic resistance on mortality, sometimes mediated by inappropriate treatment.
- A direct link between gram-negative MDR bacteria and ICU mortality could not be definitively confirmed due to methodological issues and confounders.
Conclusions:
- The direct association between gram-negative MDR bacterial infections and mortality in ICU patients is not confirmed.
- Methodological limitations, including sample size and confounders, may influence study results.
- Further research is required to elucidate the true impact of infections caused by resistant bacteria in critically ill patients.
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