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Influence of bacterial resistance on mortality in intensive care units: a registry study from 2000 to 2013 (IICU
V Bonnet1, H Dupont2, S Glorion3
1Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France.
Background:
Bacterial resistance to antibiotics is a daily concern in intensive care units. However, few data are available concerning the clinical consequences of in-vitro-defined resistance.
Aim:
To compare the mortality of patients with nosocomial infections according to bacterial resistance profiles.
Methods:
The prospective surveillance registry in 29 French intensive care units (ICUs) participating during the years 2000-2013 was retrospectively analysed. All patients presenting with a nosocomial infection in ICU were included.
Findings:
The registry contained 88,000 eligible patients, including 10,001 patients with a nosocomial infection. Among them, 3092 (36.7%) were related to resistant micro-organisms. Gram-negative bacilli exhibited the highest rate of resistance compared to Gram-positive cocci (52.8% vs 48.1%; P < 0.001). In-hospital mortality was higher in cases of patients with antibiotic-resistant infectious agents (51.9% vs 45.5%; P < 0.001), and critical care length of stay was longer (33 ± 26 vs 29 ± 22 days; P < 0.001). These results remained significant after SAPS II matching (P < 0.001) and in the Gram-negative bacilli and Gram-positive cocci subgroups. No difference in mortality was found with respect to origin prior to admission.
Conclusion:
Patients with bacterial resistance had higher ICU mortality and increased length of stay, regardless of the bacterial species or origin of the patient.
Insights
Antibiotic resistance in intensive care units (ICUs) leads to higher patient mortality and longer hospital stays. This study highlights the significant clinical consequences of bacterial resistance in ICU infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Bacterial antibiotic resistance is a significant challenge in intensive care units (ICUs).
- Limited data exist on the clinical impact of in-vitro antibiotic resistance in ICU patients.
- Nosocomial infections pose a daily threat to patient well-being in critical care settings.
Purpose of the Study:
- To compare mortality rates among patients with nosocomial infections based on bacterial resistance profiles.
- To investigate the clinical consequences of antibiotic-resistant microorganisms in intensive care.
Main Methods:
- Retrospective analysis of a prospective surveillance registry from 29 French ICUs (2000-2013).
- Inclusion of all patients diagnosed with nosocomial infections during their ICU stay.
- Comparison of mortality and length of stay between patients with resistant versus susceptible bacterial infections.
Main Results:
- Out of 10,001 patients with nosocomial infections, 3092 (36.7%) involved resistant organisms.
- In-hospital mortality was significantly higher for patients with antibiotic-resistant infections (51.9% vs. 45.5%, P < 0.001).
- Patients with resistant infections experienced a longer ICU length of stay (33 vs. 29 days, P < 0.001).
Conclusions:
- Bacterial resistance is associated with increased ICU mortality and prolonged hospital stays.
- These findings hold true regardless of the specific bacterial species or patient origin.
- The study underscores the critical clinical impact of antibiotic resistance in intensive care settings.
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