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Updated: Jun 27, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Quantitative analysis of the association between clinical antimicrobial use and healthcare-associated infections: a
Xiaoliang Zhang1, Fangbin Li2, Yan Liang3
1Department of Hospital Infection Management, The Second People's Hospital of Gansu Province, Affiliated Hospital of Northwest Minzu University, Lanzhou, Gansu Province, China.
Objectives:
To assess the association between prior antimicrobial exposure and healthcare-associated infections (HAIs) by regimen and duration.
Methods:
A five-centre case-control study was conducted. Controls were stratified by the Charlson Comorbidity Index (CCI) and selected from contemporaneous non-HAI patients. Restricted cubic spline analysis assessed non-linear trends, while subgroup analyses and adjusted logistic regression models evaluated the independent impact of antimicrobial exposure duration on HAI risk. Antimicrobial exposure duration was defined as the interval during hospitalisation from the start of antimicrobial administration to the diagnosis of HAI.
Results:
Among 794 cases, 388 had antimicrobial exposure prior to HAI onset, than the 328 in the control group. Subgroup analyses indicated that a single-agent antimicrobial regimen (SAAR) was associated with reduced HAI risk (adjusted odds ratio [aOR]: 0.74; 95% confidence interval [CI]: 0.58-0.94). In contrast, two-agent antimicrobial regimens (TAARs) (aOR: 1.84; 95% CI: 1.25-2.71) and multi-agent regimens (MAAR, ≥3 agents) (aOR: 2.59; 95% CI: 1.23-5.45) were independent risk factors. The dose-response relationship between SAAR/TAAR duration and HAI showed a J-shaped trend for SAAR and a U-shaped trend for TAAR. Stratified analyses by duration revealed that SAAR exposure for ≤3 days was an independent risk factor for HAIs (aOR: 1.56; 95% CI: 1.03-2.37). Furthermore, TAAR with a cumulative exposure of 1-6 days was confirmed as a significant independent risk factor (aOR: 2.81; 95% CI: 1.22-6.46).
Conclusion:
SAAR appears to be a relatively safe strategy with regard to HAI risk, particularly when treatment duration exceeds 3 days. However, caution should be exercised when two or more antimicrobial agents are co-administered.
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