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- Title
Impact of Difficult-to-Treat Resistance in Gram-negative Bacteremia on Mortality: Retrospective Analysis of Nationwide Surveillance Data.
- Authors
Huh, Kyungmin; Chung, Doo Ryeon; Ha, Young Eun; Ko, Jae-Hoon; Kim, Si-Ho; Kim, Min-Ji; Huh, Hee Jae; Lee, Nam Yong; Cho, Sun Young; Kang, Cheol-In; Peck, Kyong Ran; Song, Jae-Hoon; Investigators, Korean Antimicrobial Resistance Surveillance Network (KARS-Net)
- Abstract
Background Clinically relevant categorization of antimicrobial resistance is critical to mitigating the threat it poses. Difficult-to-treat resistance (DTR) is a recently proposed category defined as nonsusceptibility to all first-line antibiotic agents. Methods A retrospective study was conducted with nonduplicate cases of gram-negative bloodstream infection (GNBSI) caused by 4 major taxa (Escherichia coli , Klebsiella pneumoniae , Pseudomonas aeruginosa , and Acinetobacter species) identified from a nationwide surveillance database. DTR was defined as nonsusceptibility to all the β-lactams and fluoroquinolones tested. Patient characteristics and mortality were compared between DTR GNBSI and GNBSI caused by carbapenem-resistant but not DTR and extended-spectrum cephalosporin–resistant but not DTR isolates using Centers for Disease Control and Prevention definitions. Adjusted odds ratios (aORs) for 30-day in-hospital mortality were examined for DTR in overall and in propensity score–matched cohorts. Results A total of 1167 episodes of monomicrobial GNBSI were identified, and 147 (12.6%) of the isolates were DTR. The majority of DTR isolates were Acinetobacter species (79.6%) and P. aeruginosa (17.7%). DTR infections were associated with previous antibiotic use, healthcare contact, ventilator use, and lower respiratory tract infection. Crude mortality for GNBSI caused by DTR was 50.3%. A multivariable model showed that only DTR, but not other categories, was significantly associated with mortality (adjusted odds ratio [aOR], 3.58 [95% confidence interval {CI}, 1.27–10.19]). DTR was also a significant predictor for mortality in the analysis of propensity score–matched cohorts (aOR, 3.48 [95% CI, 1.82–6.79]). Conclusions In patients with GNBSI, DTR was associated with higher mortality than those in other resistance categories. Our findings suggest that DTR could be useful for surveillance and prognostication.
- Subjects
BACTEREMIA; CONFIDENCE intervals; DRUG resistance in microorganisms; GRAM-negative bacterial diseases; RETROSPECTIVE studies; DESCRIPTIVE statistics; ODDS ratio
- Publication
Clinical Infectious Diseases, 2020, Vol 71, Issue 9, pe487
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciaa084