Risk factors and mortality associated with multi-drug-resistant Gram-negative bacterial infection in adult patients...

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Surgical Infections

Background:

• Multi-drug-resistant Gram-negative bacterial (MDR GNB) infections pose a significant threat to surgical patients, contributing to high morbidity and mortality.
• Abdominal surgery patients are particularly vulnerable to these resistant infections.

Purpose of the Study:

• To identify risk factors associated with MDR GNB infections in patients undergoing abdominal surgery.
• To determine independent predictors of mortality in patients with MDR GNB infections post-abdominal surgery.

Main Methods:

• A retrospective cohort study was conducted from 2010 to 2017.
• Included patients with Gram-negative bacterial (GNB) infections admitted to the surgical intensive care unit (ICU) after abdominal surgery.
• Analyzed data from 364 patients with GNB infections, of whom 117 had MDR GNB infections.

Main Results:

• Multi-drug-resistant Gram-negative bacterial (MDR GNB) infections occurred in 32.1% of patients, with Escherichia coli being the most common isolate.
• Patients with MDR GNB infections experienced longer ICU stays, higher ventilator days, and increased 30-day and in-hospital mortality.
• Independent risk factors for MDR GNB acquisition included prolonged pre-ICU stay, surgical re-exploration, specific carbapenem and fluoroquinolone use, and elevated total bilirubin. Predictors of 30-day mortality included chronic kidney disease, specific carbapenem use, and inadequate empirical antimicrobial therapy.

Conclusions:

• This study highlights key risk factors for acquiring MDR GNB infections and identifies critical predictors of mortality in abdominal surgery patients.
• Findings underscore the importance of targeted interventions and appropriate antimicrobial strategies to combat MDR GNB infections in this vulnerable population.