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Prevalence, Clinical Severity, and Outcomes of Extensively Drug-Resistant and Pan-Drug-Resistant Gram-Negative
1Department of Intensive Care, Ordu University Training and Research Hospital, Ordu, Turkiye.
Background:
Extensively drug-resistant (XDR) and pan-drug-resistant (PDR) gram-negative bacteria are increasingly encountered in intensive care units (ICUs) and present a serious therapeutic challenge. However, whether resistance phenotype independently drives clinical outcomes remains unclear. This study investigated the prevalence of XDR and PDR gram-negative bacteria in a tertiary ICU and their associations with clinical course, mortality, and ventilator weaning failure.
Methods:
We retrospectively reviewed adult patients (>18 years) admitted to a tertiary general ICU and classified them as XDR, PDR, or non-XDR/PDR based on antimicrobial susceptibility results. We recorded demographic data, comorbidities, GCS scores, organ support requirements, and ICU and hospital lengths of stay. Disease severity was quantified using the APACHE II score. Predictors of mortality and weaning failure were identified by univariate and multivariate logistic regression.
Results:
XDR and PDR gram-negative infections were identified in 12.53% and 6.04% of patients, respectively. Of 463 patients, those with XDR and PDR infections had longer ICU and hospital stays, higher rates of sedation and vasopressor use, higher APACHE II scores, lower GCS scores, hypoalbuminemia, and higher mortality compared with non-XDR/PDR patients. Despite this, resistance phenotype did not independently predict mortality or weaning failure in multivariate analysis. Mortality was independently associated with higher APACHE II score, lower GCS, vasopressor and sedation requirements, elevated CRP, and low albumin. Weaning failure was independently predicted by shorter ICU stay and elevated CRP.
Conclusion:
XDR and PDR infections were associated with a more severe clinical course; however, in multivariate analysis, mortality was more strongly associated with physiological deterioration than with resistance phenotype itself.
Insights
Extensively drug-resistant (XDR) and pan-drug-resistant (PDR) gram-negative bacteria in ICUs are linked to severe illness, but physiological status, not just resistance, predicts patient mortality and weaning outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Antimicrobial Resistance
Background:
- Extensively drug-resistant (XDR) and pan-drug-resistant (PDR) gram-negative bacteria pose significant therapeutic challenges in intensive care units (ICUs).
- The independent impact of resistance phenotype on clinical outcomes for these infections remains incompletely understood.
- This study aimed to clarify the association between XDR/PDR gram-negative infections and patient outcomes in an ICU setting.
Purpose of the Study:
- To determine the prevalence of XDR and PDR gram-negative bacterial infections in a tertiary ICU.
- To investigate the association of these resistant infections with clinical course, mortality, and ventilator weaning failure.
- To identify independent predictors of mortality and weaning failure in critically ill patients.
Main Methods:
- Retrospective review of adult patients admitted to a tertiary general ICU.
- Classification of patients into XDR, PDR, or non-XDR/PDR groups based on antimicrobial susceptibility.
- Univariate and multivariate logistic regression analyses to identify predictors of mortality and weaning failure, controlling for disease severity (APACHE II score), GCS, and other clinical factors.
Main Results:
- XDR and PDR gram-negative infections were present in 12.53% and 6.04% of patients, respectively.
- Patients with XDR/PDR infections exhibited longer ICU/hospital stays, increased need for sedation and vasopressors, higher APACHE II scores, lower GCS, and higher mortality.
- However, resistance phenotype did not independently predict mortality or weaning failure in multivariate analysis; physiological deterioration (APACHE II, GCS, CRP, albumin) was the stronger predictor.
Conclusions:
- While XDR and PDR infections are associated with a more severe clinical presentation in ICUs, they do not independently predict mortality.
- Physiological deterioration and severity of illness are more critical determinants of mortality than the specific resistance phenotype of gram-negative bacteria.
- Ventilator weaning failure was independently predicted by shorter ICU stay and elevated CRP, not by drug resistance patterns.
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