Prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections among patients in an ICU
ABSTRACT Objective: To determine the prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections (LRTI) in patients in an ICU. Methods: This was an observational cohort study involving patients with nosocomial LRTI (health care-associated pneumonia, ho...
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| Format: | Article |
| Language: | English |
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Sociedade Brasileira de Pneumologia e Tisiologia
2023-01-01
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| Series: | Jornal Brasileiro de Pneumologia |
| Subjects: | |
| Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132023000100201&lng=en&tlng=en |
| _version_ | 1797944916600422400 |
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| author | Ana Beatriz Souza de Oliveira Guilherme Hirassawa Sacillotto Manuela Francisco Balthazar Neves Andressa Hellen Nora da Silva Tamiris Adriane Moimaz Joelma Villafanha Gandolfi Mara Correa Lelles Nogueira Suzana Margareth Lobo |
| author_facet | Ana Beatriz Souza de Oliveira Guilherme Hirassawa Sacillotto Manuela Francisco Balthazar Neves Andressa Hellen Nora da Silva Tamiris Adriane Moimaz Joelma Villafanha Gandolfi Mara Correa Lelles Nogueira Suzana Margareth Lobo |
| author_sort | Ana Beatriz Souza de Oliveira |
| collection | DOAJ |
| description | ABSTRACT Objective: To determine the prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections (LRTI) in patients in an ICU. Methods: This was an observational cohort study involving patients with nosocomial LRTI (health care-associated pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia). Data were prospectively collected between 2015 and 2019. The multidrug-resistant pathogens (MDRPs) identified in the isolates studied included resistant to extended-spectrum cephalosporin-resistant and carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus at microbiological diagnosis. Results: During the study period, 267 patients in the ICU were diagnosed with LRTI, microbiological confirmation of LRTI having been obtained in 237. Of these, 146 (62%) had at least one MDRP isolate. Patients infected with MDRP were found to have poorer outcomes than patients infected with susceptible strains, such as prolonged mechanical ventilation (18.0 days vs. 12.0 days; p < 0.001), prolonged ICU length of stay (23.0 days vs.16.0 days; p < 0.001), and higher mortality (73% vs. 53%; p < 0.001) when compared with patients infected with susceptible strains. Hospital length of stay ≥ 5 days (OR = 3.20; 95% CI: 1.39-7.39; p = 0.005) and prolonged use vasoactive drugs (OR = 3.15; 95% CI: 1.42-7.01; p = 0.004) were independent predictors of LRTI caused by MDRPs (LRTI-MDRP). The presence of LRTI-MDRP was found to be an independent predictor of death (OR = 2.311; 95% CI: 1.091-4.894; p = 0.028). Conclusions: Prolonged use of vasoactive drugs and prolonged hospital length of stay were independent predictors of LRTI-MDRP in this population of critically ill patients with very poor outcomes. |
| first_indexed | 2024-04-10T20:47:10Z |
| format | Article |
| id | doaj.art-a487aae6e4ea4e6c9d2254ea538e6792 |
| institution | Directory Open Access Journal |
| issn | 1806-3756 |
| language | English |
| last_indexed | 2024-04-10T20:47:10Z |
| publishDate | 2023-01-01 |
| publisher | Sociedade Brasileira de Pneumologia e Tisiologia |
| record_format | Article |
| series | Jornal Brasileiro de Pneumologia |
| spelling | doaj.art-a487aae6e4ea4e6c9d2254ea538e67922023-01-24T07:33:30ZengSociedade Brasileira de Pneumologia e TisiologiaJornal Brasileiro de Pneumologia1806-37562023-01-0149110.36416/1806-3756/e20220235Prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections among patients in an ICUAna Beatriz Souza de Oliveirahttps://orcid.org/0000-0003-2457-3439Guilherme Hirassawa Sacillottohttps://orcid.org/0000-0001-8247-3116Manuela Francisco Balthazar Neveshttps://orcid.org/0000-0002-0776-966XAndressa Hellen Nora da Silvahttps://orcid.org/0000-0002-5053-9448Tamiris Adriane Moimazhttps://orcid.org/0000-0002-3207-8043Joelma Villafanha Gandolfihttps://orcid.org/0000-0001-5325-5697Mara Correa Lelles Nogueirahttps://orcid.org/0000-0002-6070-7716Suzana Margareth Lobohttps://orcid.org/0000-0003-2726-2441ABSTRACT Objective: To determine the prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections (LRTI) in patients in an ICU. Methods: This was an observational cohort study involving patients with nosocomial LRTI (health care-associated pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia). Data were prospectively collected between 2015 and 2019. The multidrug-resistant pathogens (MDRPs) identified in the isolates studied included resistant to extended-spectrum cephalosporin-resistant and carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus at microbiological diagnosis. Results: During the study period, 267 patients in the ICU were diagnosed with LRTI, microbiological confirmation of LRTI having been obtained in 237. Of these, 146 (62%) had at least one MDRP isolate. Patients infected with MDRP were found to have poorer outcomes than patients infected with susceptible strains, such as prolonged mechanical ventilation (18.0 days vs. 12.0 days; p < 0.001), prolonged ICU length of stay (23.0 days vs.16.0 days; p < 0.001), and higher mortality (73% vs. 53%; p < 0.001) when compared with patients infected with susceptible strains. Hospital length of stay ≥ 5 days (OR = 3.20; 95% CI: 1.39-7.39; p = 0.005) and prolonged use vasoactive drugs (OR = 3.15; 95% CI: 1.42-7.01; p = 0.004) were independent predictors of LRTI caused by MDRPs (LRTI-MDRP). The presence of LRTI-MDRP was found to be an independent predictor of death (OR = 2.311; 95% CI: 1.091-4.894; p = 0.028). Conclusions: Prolonged use of vasoactive drugs and prolonged hospital length of stay were independent predictors of LRTI-MDRP in this population of critically ill patients with very poor outcomes.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132023000100201&lng=en&tlng=enDrug resistance, multipleHealthcare-associated pneumoniaPneumonia, ventilator-associatedCross infectionIntensive care units |
| spellingShingle | Ana Beatriz Souza de Oliveira Guilherme Hirassawa Sacillotto Manuela Francisco Balthazar Neves Andressa Hellen Nora da Silva Tamiris Adriane Moimaz Joelma Villafanha Gandolfi Mara Correa Lelles Nogueira Suzana Margareth Lobo Prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections among patients in an ICU Jornal Brasileiro de Pneumologia Drug resistance, multiple Healthcare-associated pneumonia Pneumonia, ventilator-associated Cross infection Intensive care units |
| title | Prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections among patients in an ICU |
| title_full | Prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections among patients in an ICU |
| title_fullStr | Prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections among patients in an ICU |
| title_full_unstemmed | Prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections among patients in an ICU |
| title_short | Prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections among patients in an ICU |
| title_sort | prevalence outcomes and predictors of multidrug resistant nosocomial lower respiratory tract infections among patients in an icu |
| topic | Drug resistance, multiple Healthcare-associated pneumonia Pneumonia, ventilator-associated Cross infection Intensive care units |
| url | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132023000100201&lng=en&tlng=en |
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