Epidemiologic Risk Factors of Antimicrobial Resistance in Patients with Septic Shock Admitted to North American Critical Care Units: A Retrospective Cohort
CCCF ePoster library. Kutsogiannis J. Nov 7, 2018; 233333
Dr. Jim Kutsogiannis
Dr. Jim Kutsogiannis
Login now to access Regular content available to all registered users.

You may also access this content "anytime, anywhere" with the Free MULTILEARNING App for iOS and Android
Abstract
Rate & Comment (0)

INTRODUCTION

Antibiotic resistance is a serious global threat resulting in a significant clinical and economic burden. Identifying resistance between different epidemiological groups is required to identify sub-populations of ICU patients who may be more susceptible to life-threatening infections caused by resistant pathogens.  

OBJECTIVES

 The specific aim of this retrospective cohort study was to determine the frequency of resistant organisms among different epidemiological sub-groups of patients within the Cooperative Anti-microbial Therapy of Septic Shock (CATSS) Database with an ICU admission diagnosis of septic shock.

METHODS

We conducted a retrospective review of a critically ill patients with septic shock within the CATSS Database between 1996 and 2012. The presence or absence of resistant organisms was pre specified. Multivariable logistic regression analysis was used to describe independent predictors of the presence of antibiotic resistance and the effect of antibiotic resistance on ICU and hospital mortality among patients with septic shock.

 RESULTS

Increasing age (OR 1.00 95% CI 1.00,1.03) , liver failure (OR 1.23 95% CI 1.03,1.46), ventilator dependence (OR 2.09 95% CI 1.16,3.76) diabetes mellitus requiring insulin (OR 1.22 95% CI 1.04,1.42), elective surgery (OR 1.33 95% CI 1.17,1.52) and emergent surgery (OR 1.24 95% CI 1.05,1.48), neuromuscular disease (OR 1.54 95% CI 1.15,2.06) and nosocomial acquired infection (OR 1.70 95% CI 1.52,1.90) were independent predictors of the increased odds of the presence of any resistant organism at the time of diagnosis of septic shock.  Leukemia (OR 0.80 95% CI 0.64, 1.00) and the history of hypertension (OR 0.86, 95% CI 0.78, 0.96) were independent predictors of reduced odds of the presence of any resistant organism at the time of diagnosis of septic shock.  

In the multivariable model, the presence of any antibiotic resistant organism was not an independent predictor of either ICU or hospital mortality. However,  increasing age (OR 1.03 95% CI  1.02,1.03), APACHE (OR 1.10 95% CI 1.09,1.11), AIDS (OR 2.32 95% CI 1.65,3.26), lymphoma (OR 1.99 95% CI 1.47,2.69) metastatic cancer (OR 1.36 95% CI 1.15,1.62) , liver failure (OR 3.36, 95% CI 2.70,4.18) chronic dialysis (OR 1.40 95% CI 1.09,1.79) emergent surgery (OR 1.34 95% CI 1.090,1.65) ICU admission source from a medical ward (OR 1.44 95% CI 1.24,1.67) and nosocomial acquired infection (OR 2.04 95% CI 1.78,2.33) were independent predictors of increased odds of hospital mortality.

Admission source from the emergency room (other hospital ER OR 0.54, 95% CI 0.44, 0.67 or the same hospital ER OR 0.73 95% CI 0.62, 0.85), and history of hypertension (OR 0.82, 95% CI 0.72, 0.92) were independent predictors of reduced odds of hospital mortality.

CONCLUSION

Increasing age, liver failure, ventilator dependence, insulin dependent diabetes, elective and emergent surgery, neuromuscular disease and nosocomial acquired infection were predictors of increased odds of the presence of antibiotic resistance at the time of septic shock.

Increasing age, APACHE, AIDS, lymphoma, metastatic cancer, liver failure, chronic dialysis, emergent surgery medical ward admission source and nosocomial acquired infection were independent predictors of hospital mortality.   Hypertension and ER origin were independent predictor of reduced odds of hospital mortality. We did not show a significant relationship between the presence of any antibiotic resistant organism and mortality.

 


    This eLearning portal is powered by:
    This eLearning portal is powered by MULTIEPORTAL
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.


Save Settings