The rising influx of multidrug-resistant gram-negative bacilli into a tertiary care hospital

被引:108
作者
Pop-Vicas, AE [1 ]
D'Agata, EMC [1 ]
机构
[1] Harvard Univ, Div Infect Dis, Med Ctr, Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
关键词
D O I
10.1086/430314
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. The prevalence of multidrug resistance (MDR) among gram-negative bacilli is rapidly increasing. Quantification of the prevalence and the common antimicrobial coresistance patterns of MDR gram-negative bacilli (MDR- GNB) isolates recovered from patients at hospital admission, as well as identification of patients with a high risk of harboring MDR- GNB, would have important implications for patient care. Methods. Over a 6-year period, patients who harbored MDR- GNB ( i. e., patients who had MDR- GNB isolates recovered from clinical cultures within the first 48 h after hospital admission) were identified. " MDR- GNB isolates" were defined as Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, and Klebsiella species isolates with resistance to at least 3 antimicrobial groups. A case-control study was performed to determine the independent risk factors for harboring MDR- GNB at hospital admission. Results. Between 1998 and 2003, the prevalence of MDR- GNB isolates recovered from patients at hospital admission increased significantly for all isolate species (P < .001), with the exception of P. aeruginosa (p = .09). Of 464 MDR- GNB isolates, 12%, 35%, and 53% of isolates were coresistant to 5, 4, and 3 antimicrobial groups, respectively. Multivariable analysis identified age >= 65 years (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.1 - 7.4; P < .04), prior exposure to antibiotics for >= 14 days ( OR, 8.7; 95% CI, 2.5 - 30; P < .001), and prior residence in a long-term care facility (OR, 3.5; 95% CI, 1.3 - 9.4; P < .01) as independent risk factors for harboring MDR- GNB at hospital admission. Conclusion. A substantial number of patients harbor MDR- GNB at hospital admission. Identification of common coresistance patterns among MDR- GNB isolates may assist in the selection of empirical antimicrobial therapy for patients with a high risk of harboring MDR- GNB.
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页码:1792 / 1798
页数:7
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