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Association between mortality and highly antimicrobial-resistant bacteria in intensive care unit-acquired pneumonia

Ines Lakbar1,2, Sophie Medam1, Romain Ronflé1

  • 1Department of Anesthesiology and Intensive Care Unit, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Nord Hospital, Marseille, France.

Scientific Reports
|August 14, 2021
PubMed

Insights

Patients with intensive care unit (ICU)-acquired pneumonia from highly antimicrobial-resistant (HAMR) bacteria face higher mortality rates. This study highlights the critical impact of HAMR infections in ICUs, emphasizing the need for targeted interventions.

Area of Science:

  • Infectious Diseases
  • Critical Care Medicine
  • Microbiology

Background:

  • Antimicrobial resistance (AMR) poses a significant global health threat, particularly in intensive care units (ICUs).
  • Data linking specific antimicrobial-resistant bacterial infections to patient mortality in ICUs are limited.
  • Healthcare-associated infections (HAIs) caused by highly antimicrobial-resistant (HAMR) bacteria are a growing concern in critical care settings.

Purpose of the Study:

  • To compare intensive care unit (ICU) mortality rates between patients with ICU-acquired pneumonia caused by highly antimicrobial-resistant (HAMR) bacteria and those with pneumonia caused by non-HAMR bacteria.
  • To investigate the association between HAMR bacterial pneumonia and patient outcomes in the ICU.

Main Methods:

  • A multicenter, retrospective cohort study was conducted using the French National Surveillance Network for Healthcare Associated Infection in ICUs (REA-Raisin) database.
  • Data from 200 ICUs between January 2007 and December 2016 were analyzed for adult patients with ICU-acquired pneumonia caused by S. aureus, Enterobacteriaceae, P. aeruginosa, or A. baumannii.
  • Statistical analyses, including matched-pair analysis and adjustment for confounding factors, were used to assess the association between HAMR bacteria and ICU mortality.

Main Results:

  • Out of 18,497 patients with ICU-acquired pneumonia from targeted bacteria, 16.4% (3081 patients) had infections caused by HAMR bacteria.
  • Patients with HAMR bacterial pneumonia exhibited significantly higher ICU mortality rates (40.3% vs. 30%) compared to those with non-HAMR bacteria (OR 1.57; P < 0.001).
  • This association persisted after matching and adjustment for confounding factors (OR 1.34–1.39; P < 0.001), and was linked to longer ICU stays and mechanical ventilation durations.

Conclusions:

  • ICU-acquired pneumonia caused by highly antimicrobial-resistant bacteria is independently associated with increased ICU mortality.
  • These findings underscore the critical impact of HAMR bacterial infections on patient outcomes in intensive care settings.
  • The study highlights the urgent need for enhanced surveillance and control strategies for HAMR pathogens in ICUs to mitigate mortality and morbidity.

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