Current Status and Survival Impact of Infectious Disease Consultation for Multidrug-Resistant Bacteremia in Ventilated Patients: A Single-Center Experience in Korea
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: We evaluated the current status and survival impact of infectious disease consultation (IDC) in ventilated patients with multidrug-resistant (MDR) bacteremia. Methods: One hundred sixty-one consecutive patients from a single tertiary care hospital were enrolled over a 5-year period. Patients with at least one of the following six MDR bacteremias were included: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), and vancomycin-resistant Enterococcus faecium. Results: Median patient age was 66 years (range, 18 to 95), and 57.8% of subjects were male. The 28-day mortality after the day of blood culture was 52.2%. An IDC was requested for 96 patients based on a positive blood culture (59.6%). Patients without IDC had significantly higher rate of hemato-oncologic diseases as a comorbidity (36.9% vs. 11.5%, P < 0.001). Patients without an IDC had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (median, 20; range, 8 to 38 vs. median, 16; range, 5 to 34, P < 0.001) and Sequential Organ Failure Assessment (SOFA) score (median, 9; range, 2 to 17 vs. median, 7; range, 2 to 20; P = 0.020) on the day of blood culture and a higher 28-day mortality rate (72.3% vs. 38.5%, P < 0.001). In patients with SOFA ≥9 (cut-off level based on Youden’s index) on the day of blood culture and gram-negative bacteremia, IDC was also significantly associated with lower 28-day mortality (hazard ratio [HR], 0.298; 95% confidence interval [CI], 0.167 to 0.532 and HR, 0.180; 95% CI, 0.097 to 0.333; all P < 0.001) based on multivariate Cox regression analysis. Conclusions: An IDC for MDR bacteremia was requested less often for ventilated patients with greater disease severity and higher 28- day mortality after blood was drawn. In patients with SOFA ≥9 on the day of blood culture and gram-negative bacteremia, IDC was associated with improved 28-day survival after blood draw for culture.
Abstract
Background: We evaluated the current status and survival impact of infectious disease consultation (IDC) in ventilated patients with multidrug-resistant (MDR) bacteremia. Methods: One hundred sixty-one consecutive patients from a single tertiary care hospital were enrolled over a 5-year period. Patients with at least one of the following six MDR bacteremias were included: methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing gram-negative bacteria (Escherichia coli and Klebsiella pneumonia), carbapenem-resistant gram-negative rods (Acinetobacter baumannii and Pseudomonas aeruginosa), and vancomycin-resistant Enterococcus faecium. Results: Median patient age was 66 years (range, 18 to 95), and 57.8% of subjects were male. The 28-day mortality after the day of blood culture was 52.2%. An IDC was requested for 96 patients based on a positive blood culture (59.6%). Patients without IDC had significantly higher rate of hemato-oncologic diseases as a comorbidity (36.9% vs. 11.5%, P < 0.001). Patients without an IDC had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (median, 20; range, 8 to 38 vs. median, 16; range, 5 to 34, P < 0.001) and Sequential Organ Failure Assessment (SOFA) score (median, 9; range, 2 to 17 vs. median, 7; range, 2 to 20; P = 0.020) on the day of blood culture and a higher 28-day mortality rate (72.3% vs. 38.5%, P < 0.001). In patients with SOFA ≥9 (cut-off level based on Youden’s index) on the day of blood culture and gram-negative bacteremia, IDC was also significantly associated with lower 28-day mortality (hazard ratio [HR], 0.298; 95% confidence interval [CI], 0.167 to 0.532 and HR, 0.180; 95% CI, 0.097 to 0.333; all P < 0.001) based on multivariate Cox regression analysis. Conclusions: An IDC for MDR bacteremia was requested less often for ventilated patients with greater disease severity and higher 28- day mortality after blood was drawn. In patients with SOFA ≥9 on the day of blood culture and gram-negative bacteremia, IDC was associated with improved 28-day survival after blood draw for culture.
참고문헌 (26)
- Brusselaers N, "The rising problem of antimicrobial resistance in the intensive care unit", Ann Intensive Care, 1, pp.47~ (2011)[DOI]
- Magiorakos AP, "Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance", Clin Microbiol Infect, 18, pp.268~281 (2012)[DOI]
- Vardakas KZ, "Predictors of mortality in patients with infections due to multi-drug resistant Gram negative bacteria: the study, the patient, the bug or the drug?", J Infect, 66, pp.401~414 (2013)[DOI]
- Magill SS, "Multistate point-prevalence survey of health care-associated infections", N Engl J Med, 370, pp.1198~1208 (2014)[DOI]
- Levy Hara G, "Ten key points for the appropriate use of antibiotics in hospitalised patients: a consensus from the Antimicrobial Stewardship and Resistance Working Groups of the International Society of Chemotherapy", Int J Antimicrob Agents, 48, pp.239~246 (2016)[DOI]
- Levy-Hara G, "Ten commandments for the appropriate use of antibiotics by the practicing physician in an outpatient setting", Front Microbiol, 2, pp.230~ (2011)
- Pulcini C, "Design of a 'day 3 bundle' to improve the reassessment of inpatient empirical antibiotic prescriptions", J Antimicrob Chemother, 61, pp.1384~1388 (2008)[DOI]
- Pulcini C, "The impact of infectious disease specialists on antibiotic prescribing in hospitals", Clin Microbiol Infect, 20, pp.963~972 (2014)[DOI]
- Schmitt S, "Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs", Clin Infect Dis, 58, pp.22~28 (2014)[DOI]
- Kim JH, "Influence of full-time intensivist and the nurse-to-patient ratio on the implementation of severe sepsis bundles in Korean intensive care units", J Crit Care, 27, pp.414.e11~414.e12 (2012)[DOI]
- 곽상현, "Current Status of Intensive Care Units Registered as Critical Care Subspecialty Training Hospitals in Korea", Journal of Korean Medical Science, 29(3), pp.431~437 (2014), 대한의학회
- Dellinger RP, "Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012", Intensive Care Med, 39, pp.165~228 (2013)[DOI]
- Acute Respiratory Distress Syndrome Network, "Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome", N Engl J Med, 342, pp.1301~1308 (2000)[DOI]
- Knaus WA, "APACHE II: a severity of disease classification system", Crit Care Med, 13, pp.818~829 (1985)[DOI]
- Vincent JL, "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction", failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
- Perkins NJ, "The inconsistency of optimal cutpoints obtained using two criteria based on the receiver operating characteristic curve", Am J Epidemiol, 163, pp.670~675 (2006)[DOI]
- Turner RB, "Impact of infectious diseases consultation on clinical outcomes of patients with Staphylococcus aureus bacteremia in a community health system", Antimicrob Agents Chemother, 60, pp.5682~5687 (2016)[DOI]
- Bai AD, "Impact of infectious disease consultation on quality of care, mortality, and length of stay in Staphylococcus aureus bacteremia: results from a large multicenter cohort study", Clin Infect Dis, 60, pp.1451~1461 (2015)[DOI]
- Tedeschi S, "An antimicrobial stewardship program based on systematic infectious disease consultation in a rehabilitation facility", Infect Control Hosp Epidemiol, 38, pp.76~82 (2017)[DOI]
- Hamandi B, "Impact of infectious disease consultation on the clinical and economic outcomes of solid organ transplant recipients admitted for infectious complications", Clin Infect Dis, 59, pp.1074~1082 (2014)[DOI]
- Choi SH, "Impact of infectious-disease specialist consultations on outcomes of Staphylococcus aureus bacteremia in a hospital with a low volume of patients with S. aureus bacteremia", J Infect, 62, pp.181~185 (2011)[DOI]
- Howard P, "An international cross-sectional survey of antimicrobial stewardship programmes in hospitals", J Antimicrob Chemother, 70, pp.1245~1255 (2015)
- Holloway KA, "The Impact of WHO essential medicines policies on inappropriate use of antibiotics", PLoS One, 11, pp.e0152020~ (2016)[DOI]
- Saunderson RB, "Impact of routine bedside infectious disease consultation on clinical management and outcome of Staphylococcus aureus bacteraemia in adults", Clin Microbiol Infect, 21, pp.779~785 (2015)[DOI]
- Robinson JO, "Formal infectious diseases consultation is associated with decreased mortality in Staphylococcus aureus bacteraemia", Eur J Clin Microbiol Infect Dis, 31, pp.2421~2428 (2012)[DOI]
- Fries BL, "Infectious diseases consultation and the management of Staphylococcus aureus bacteremia", Clin Infect Dis, 58, pp.598~599 (2014)[DOI]