Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant <i>Klebsiella pneumoniae</i> in Intensive Care Unit Patients: A Nested Case–Control Study
Epidemiological research has demonstrated direct relationships between antibiotic consumption and the emergence of multidrug-resistant (MDR) bacteria. In this nested case–control study, we assessed whether prior exposure to antibiotic therapy and its duration affect the onset of healthcare-associate...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-03-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/10/3/302 |
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| author | Giuseppe Migliara Valentina Baccolini Claudia Isonne Sara Cianfanelli Carolina Di Paolo Annamaria Mele Lorenza Lia Angelo Nardi Carla Salerno Susanna Caminada Vittoria Cammalleri Francesco Alessandri Guglielmo Tellan Giancarlo Ceccarelli Mario Venditti Francesco Pugliese Carolina Marzuillo Corrado De Vito Maria De Giusti Paolo Villari |
| author_facet | Giuseppe Migliara Valentina Baccolini Claudia Isonne Sara Cianfanelli Carolina Di Paolo Annamaria Mele Lorenza Lia Angelo Nardi Carla Salerno Susanna Caminada Vittoria Cammalleri Francesco Alessandri Guglielmo Tellan Giancarlo Ceccarelli Mario Venditti Francesco Pugliese Carolina Marzuillo Corrado De Vito Maria De Giusti Paolo Villari |
| author_sort | Giuseppe Migliara |
| collection | DOAJ |
| description | Epidemiological research has demonstrated direct relationships between antibiotic consumption and the emergence of multidrug-resistant (MDR) bacteria. In this nested case–control study, we assessed whether prior exposure to antibiotic therapy and its duration affect the onset of healthcare-associated infections (HAIs) sustained by MDR <i>Klebsiella pneumoniae</i> (MDR-Kp) in intensive care unit patients. Cases were defined as patients who developed an MDR-Kp HAI. Controls matched on sex and the length of intensive care unit (ICU) stay were randomly selected from the at-risk population. Any antibiotic agent received in systemic administration before the onset of infection was considered as antibiotic exposure. Multivariable conditional logistic regression analyses were performed to estimate the effect of prior exposure to each antibiotic class (Model 1) or its duration (Model 2) on the onset of HAIs sustained by MDR-Kp. Overall, 87 cases and 261 gender-matched controls were compared. In Model 1, aminoglycosides and linezolid independently increased the likelihood of developing an MDR-Kp HAI, whereas exposure to both linezolid and penicillins reduced the effect of linezolid alone. In Model 2, cumulative exposure to aminoglycosides increased the likelihood of the outcome, as well as cumulative exposures to penicillins and colistin, while a previous exposure to both penicillins and colistin reduced the influence of the two antibiotic classes alone. Our study confirms that aminoglycosides, penicillins, linezolid, and colistin may play a role in favoring the infections sustained by MDR-Kp. However, several double exposures in the time window before HAI onset seemed to hinder the selective pressure exerted by individual agents. |
| first_indexed | 2024-03-10T13:14:00Z |
| format | Article |
| id | doaj.art-ebe117672cdd411f98793eb863a3182f |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T13:14:00Z |
| publishDate | 2021-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-ebe117672cdd411f98793eb863a3182f2023-11-21T10:33:22ZengMDPI AGAntibiotics2079-63822021-03-0110330210.3390/antibiotics10030302Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant <i>Klebsiella pneumoniae</i> in Intensive Care Unit Patients: A Nested Case–Control StudyGiuseppe Migliara0Valentina Baccolini1Claudia Isonne2Sara Cianfanelli3Carolina Di Paolo4Annamaria Mele5Lorenza Lia6Angelo Nardi7Carla Salerno8Susanna Caminada9Vittoria Cammalleri10Francesco Alessandri11Guglielmo Tellan12Giancarlo Ceccarelli13Mario Venditti14Francesco Pugliese15Carolina Marzuillo16Corrado De Vito17Maria De Giusti18Paolo Villari19Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Anesthesia and Intensive Care Medicine Azienda, Universitaria-Ospedaliera Policlinico Umberto I, 00185 Rome, ItalyDepartment of Anesthesia and Intensive Care Medicine Azienda, Universitaria-Ospedaliera Policlinico Umberto I, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Anesthesia and Intensive Care Medicine Azienda, Universitaria-Ospedaliera Policlinico Umberto I, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, ItalyEpidemiological research has demonstrated direct relationships between antibiotic consumption and the emergence of multidrug-resistant (MDR) bacteria. In this nested case–control study, we assessed whether prior exposure to antibiotic therapy and its duration affect the onset of healthcare-associated infections (HAIs) sustained by MDR <i>Klebsiella pneumoniae</i> (MDR-Kp) in intensive care unit patients. Cases were defined as patients who developed an MDR-Kp HAI. Controls matched on sex and the length of intensive care unit (ICU) stay were randomly selected from the at-risk population. Any antibiotic agent received in systemic administration before the onset of infection was considered as antibiotic exposure. Multivariable conditional logistic regression analyses were performed to estimate the effect of prior exposure to each antibiotic class (Model 1) or its duration (Model 2) on the onset of HAIs sustained by MDR-Kp. Overall, 87 cases and 261 gender-matched controls were compared. In Model 1, aminoglycosides and linezolid independently increased the likelihood of developing an MDR-Kp HAI, whereas exposure to both linezolid and penicillins reduced the effect of linezolid alone. In Model 2, cumulative exposure to aminoglycosides increased the likelihood of the outcome, as well as cumulative exposures to penicillins and colistin, while a previous exposure to both penicillins and colistin reduced the influence of the two antibiotic classes alone. Our study confirms that aminoglycosides, penicillins, linezolid, and colistin may play a role in favoring the infections sustained by MDR-Kp. However, several double exposures in the time window before HAI onset seemed to hinder the selective pressure exerted by individual agents.https://www.mdpi.com/2079-6382/10/3/302healthcare-associated infectionsantibiotic exposureintensive care unitmultidrug resistance<i>Klebsiella pneumoniae</i> |
| spellingShingle | Giuseppe Migliara Valentina Baccolini Claudia Isonne Sara Cianfanelli Carolina Di Paolo Annamaria Mele Lorenza Lia Angelo Nardi Carla Salerno Susanna Caminada Vittoria Cammalleri Francesco Alessandri Guglielmo Tellan Giancarlo Ceccarelli Mario Venditti Francesco Pugliese Carolina Marzuillo Corrado De Vito Maria De Giusti Paolo Villari Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant <i>Klebsiella pneumoniae</i> in Intensive Care Unit Patients: A Nested Case–Control Study Antibiotics healthcare-associated infections antibiotic exposure intensive care unit multidrug resistance <i>Klebsiella pneumoniae</i> |
| title | Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant <i>Klebsiella pneumoniae</i> in Intensive Care Unit Patients: A Nested Case–Control Study |
| title_full | Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant <i>Klebsiella pneumoniae</i> in Intensive Care Unit Patients: A Nested Case–Control Study |
| title_fullStr | Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant <i>Klebsiella pneumoniae</i> in Intensive Care Unit Patients: A Nested Case–Control Study |
| title_full_unstemmed | Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant <i>Klebsiella pneumoniae</i> in Intensive Care Unit Patients: A Nested Case–Control Study |
| title_short | Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant <i>Klebsiella pneumoniae</i> in Intensive Care Unit Patients: A Nested Case–Control Study |
| title_sort | prior antibiotic therapy and the onset of healthcare associated infections sustained by multidrug resistant i klebsiella pneumoniae i in intensive care unit patients a nested case control study |
| topic | healthcare-associated infections antibiotic exposure intensive care unit multidrug resistance <i>Klebsiella pneumoniae</i> |
| url | https://www.mdpi.com/2079-6382/10/3/302 |
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