The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study
Abstract Background In the recent era, antimicrobial resistance has been identified as one of the most important threats to human health worldwide. The rapid emergence of antibiotic-resistant pathogens (ABRP) in the modern intensive care unit (ICU) also represents a “nightmare scenario” with unknown...
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | Health and Quality of Life Outcomes |
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| Online Access: | https://doi.org/10.1186/s12955-021-01712-0 |
| _version_ | 1818677603331997696 |
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| author | Triantafyllia Koukoubani Demosthenes Makris Zoe Daniil Theoniki Paraforou Vasiliki Tsolaki Epaminondas Zakynthinos John Papanikolaou |
| author_facet | Triantafyllia Koukoubani Demosthenes Makris Zoe Daniil Theoniki Paraforou Vasiliki Tsolaki Epaminondas Zakynthinos John Papanikolaou |
| author_sort | Triantafyllia Koukoubani |
| collection | DOAJ |
| description | Abstract Background In the recent era, antimicrobial resistance has been identified as one of the most important threats to human health worldwide. The rapid emergence of antibiotic-resistant pathogens (ABRP) in the modern intensive care unit (ICU) also represents a “nightmare scenario” with unknown clinical consequences. In the Greek ICU, in particular, gram negative ABRPs are now considered endemic. However, the possible longitudinal impact of ABRPs on long-term outcomes of ICU patients has not yet been determined. Methods In this two-year (January 2014-December 2015) single-centre observational longitudinal study, 351 non-neurocritical ICU patients ≥ 18 year-old were enrolled. Patients’ demographic, clinical and outcome data were prospectively collected. Quality-adjusted life years (QALY) were calculated at 6, 12, 18 and 24 months after ICU admission. Results Fifty-eight patients developed infections due to ABRP (ABRP group), 57 due to non-ABRP (non-ABRP group), and 236 demonstrated no infection (no-infection group) while in ICU. Multiple regression analysis revealed that multiple organ dysfunction syndrome score (OR: 0.676, 95%CI 0.584–0.782; P < 0.001) and continuous renal replacement therapy (OR: 4.453, 95%CI 1.805–10.982; P = 0.001) were the only independent determinants for ABRP infections in ICU. Intra-ICU, 90-day and 2-year mortality was 27.9%, 52.4% and 61.5%, respectively. Compared to the non-ABRP and no-infection group, the ABRP group demonstrated increased intra-ICU, 90-day and 2-year mortality (P ≤ 0.022), worse 2-year survival rates in ICU patients overall and ICU survivor subset (Log-rank test, P ≤ 0.046), and poorer progress over time in 2-year QALY kinetics in ICU population overall, ICU survivor and 2-year survivor subgroups (P ≤ 0.013). ABRP group was further divided into multi-drug and extensively-drug resistant subgroups [MDR (n = 34) / XDR (n = 24), respectively]. Compared to MDR subgroup, the XDR subgroup demonstrated increased ICU, 90-day and 2-year mortality (P ≤ 0.031), but similar 90-day and 2-year QALYs (P ≥ 0.549). ABRP infections overall (HR = 1.778, 95% CI 1.166–2.711; P = 0.008), as well as XDR [HR = 1.889, 95% CI 1.075–3.320; P = 0.027) but not MDR pathogens, were independently associated with 2-year mortality, after adjusting for several covariates of critical illness. Conclusions The present study may suggest a significant association between ABRP (especially XDR) infections in ICU and increased mortality and inability rates for a prolonged period post-discharge that requires further attention in larger-scale studies. |
| first_indexed | 2024-12-17T09:02:00Z |
| format | Article |
| id | doaj.art-6d94266f7aee4924be70fc13dd67b926 |
| institution | Directory Open Access Journal |
| issn | 1477-7525 |
| language | English |
| last_indexed | 2024-12-17T09:02:00Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Health and Quality of Life Outcomes |
| spelling | doaj.art-6d94266f7aee4924be70fc13dd67b9262022-12-21T21:55:41ZengBMCHealth and Quality of Life Outcomes1477-75252021-03-0119111210.1186/s12955-021-01712-0The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year studyTriantafyllia Koukoubani0Demosthenes Makris1Zoe Daniil2Theoniki Paraforou3Vasiliki Tsolaki4Epaminondas Zakynthinos5John Papanikolaou6Department of Critical Care, General Hospital of TrikalaDepartment of Critical Care, School of Medicine, University of Thessaly, University Hospital of LarissaDepartment of Critical Care, School of Medicine, University of Thessaly, University Hospital of LarissaDepartment of Critical Care, General Hospital of TrikalaDepartment of Critical Care, School of Medicine, University of Thessaly, University Hospital of LarissaDepartment of Critical Care, School of Medicine, University of Thessaly, University Hospital of LarissaDepartment of Critical Care, School of Medicine, University of Thessaly, University Hospital of LarissaAbstract Background In the recent era, antimicrobial resistance has been identified as one of the most important threats to human health worldwide. The rapid emergence of antibiotic-resistant pathogens (ABRP) in the modern intensive care unit (ICU) also represents a “nightmare scenario” with unknown clinical consequences. In the Greek ICU, in particular, gram negative ABRPs are now considered endemic. However, the possible longitudinal impact of ABRPs on long-term outcomes of ICU patients has not yet been determined. Methods In this two-year (January 2014-December 2015) single-centre observational longitudinal study, 351 non-neurocritical ICU patients ≥ 18 year-old were enrolled. Patients’ demographic, clinical and outcome data were prospectively collected. Quality-adjusted life years (QALY) were calculated at 6, 12, 18 and 24 months after ICU admission. Results Fifty-eight patients developed infections due to ABRP (ABRP group), 57 due to non-ABRP (non-ABRP group), and 236 demonstrated no infection (no-infection group) while in ICU. Multiple regression analysis revealed that multiple organ dysfunction syndrome score (OR: 0.676, 95%CI 0.584–0.782; P < 0.001) and continuous renal replacement therapy (OR: 4.453, 95%CI 1.805–10.982; P = 0.001) were the only independent determinants for ABRP infections in ICU. Intra-ICU, 90-day and 2-year mortality was 27.9%, 52.4% and 61.5%, respectively. Compared to the non-ABRP and no-infection group, the ABRP group demonstrated increased intra-ICU, 90-day and 2-year mortality (P ≤ 0.022), worse 2-year survival rates in ICU patients overall and ICU survivor subset (Log-rank test, P ≤ 0.046), and poorer progress over time in 2-year QALY kinetics in ICU population overall, ICU survivor and 2-year survivor subgroups (P ≤ 0.013). ABRP group was further divided into multi-drug and extensively-drug resistant subgroups [MDR (n = 34) / XDR (n = 24), respectively]. Compared to MDR subgroup, the XDR subgroup demonstrated increased ICU, 90-day and 2-year mortality (P ≤ 0.031), but similar 90-day and 2-year QALYs (P ≥ 0.549). ABRP infections overall (HR = 1.778, 95% CI 1.166–2.711; P = 0.008), as well as XDR [HR = 1.889, 95% CI 1.075–3.320; P = 0.027) but not MDR pathogens, were independently associated with 2-year mortality, after adjusting for several covariates of critical illness. Conclusions The present study may suggest a significant association between ABRP (especially XDR) infections in ICU and increased mortality and inability rates for a prolonged period post-discharge that requires further attention in larger-scale studies.https://doi.org/10.1186/s12955-021-01712-0Health-related quality of lifeQuality-adjusted life yearsLong-term outcomesMortalityPatient-important outcomesMulti-drug resistance |
| spellingShingle | Triantafyllia Koukoubani Demosthenes Makris Zoe Daniil Theoniki Paraforou Vasiliki Tsolaki Epaminondas Zakynthinos John Papanikolaou The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study Health and Quality of Life Outcomes Health-related quality of life Quality-adjusted life years Long-term outcomes Mortality Patient-important outcomes Multi-drug resistance |
| title | The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study |
| title_full | The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study |
| title_fullStr | The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study |
| title_full_unstemmed | The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study |
| title_short | The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study |
| title_sort | role of antimicrobial resistance on long term mortality and quality of life in critically ill patients a prospective longitudinal 2 year study |
| topic | Health-related quality of life Quality-adjusted life years Long-term outcomes Mortality Patient-important outcomes Multi-drug resistance |
| url | https://doi.org/10.1186/s12955-021-01712-0 |
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