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Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli

Christian G. Giske, Dominique L. Monnet, Otto Cars, Yehuda Carmeli, ; on behalf of ReAct-Action on Antibiotic Resistance
Christian G. Giske
1Clinical Microbiology L2:02, Karolinska Institutet-MTC, Karolinska University Hospital Solna, SE-17176 Stockholm, Sweden
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  • For correspondence: christian.giske@karolinska.se
Dominique L. Monnet
2National Center for Antimicrobials and Infection Control, Statens SerumInstitut, Copenhagen, Denmark
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Otto Cars
3Antibiotic Research Unit, Department of Medical Sciences, Clinical Bacteriology and Infectious Diseases, Uppsala University, Uppsala, Sweden
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Yehuda Carmeli
4Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts
5Division of Epidemiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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DOI: 10.1128/AAC.01169-07
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Tables

  • TABLE 1.

    Prevalence of resistance to extended-spectrum cephalosporins in E. coli and K. pneumoniae in various parts of the world

    RegionPeriodSettingResistance (%)Reference
    K. pneumoniaeE. coli
    North America
        United States2003ICU20.65.8 50
        United States2004Intra-abdominal infections5.32.8 63
        United States (Brooklyn)2006All infections59 40
    Latin America
        Seven countries2000Urinary tract infections22.33.1 25
        Ten countries2004Intra-abdominal infections27.612.0 63
    Europe
        Northern Europe2000-2001Nosocomial infections5.21.4 7
        Southern Europe2000-2001Nosocomial infections25.76.6 7
        Nine countries2004Intra-abdominal infections8.86.4 63
    Asia
        China1998-2002Nosocomial infections37.331.3 30
        Japan1998-2002Nosocomial infections11.06.5 30
        Singapore1998-2002Nosocomial infections36.412.3 30
    Oceania (Australia)1998-2002Nosocomial infections4.61.6 30
    South Africa1998-2002Nosocomial infections29.61.9 30
  • TABLE 2.

    Impact of extended-spectrum cephalosporin resistance in Enterobacteriaceae on mortality, LOS, and hospital cost

    Type of studySettingType of infectionBacteriaNo. of cases/no. of controlsParameterMain findingsSignificance (P value or 95% CI)Reference
    Studies showing an impact of resistance
        Case-controlTertiary careNosocomial E. coli and K. pneumoniae33/66aLOSCases, 1.76 times greater duration1.17-2.64 42
    Increased costCases, 2.90 times higher cost1.76-4.78
        Case-controlTertiary careBSI K. pneumoniae 44/118aLOSCases, 39.6 days; controls, 23.9 days P < 0.008 38
        Case-controlMulticenterNosocomial K. pneumoniae 9/9MortalityCases, 44%; controls, 33% P > 0.05 9
    LOSCases, 37 ± 25 days; controls, 15 ± 10 days P = 0.04
        Case-controlTertiary carePeritonitis (CAPDb) E. coli 11/77MortalityCases, 27.3%; controls, 3.9% P = 0.02 83
        Retrospective cohortTertiary careBSI Enterobacteriaceae 99/99aLOSCases, 1.56 greater duration P = 0.001 68
    Increased costCases, 1.57 times higher cost P = 0.003
        Retrospective cohortTertiary careNon-urinary tract E. coli and Klebsiella spp.21/21aMortalityCases, 8%; controls, 14% P = 0.182 44
    LOSCases, 21 days; controls, 11 days P = 0.006
    Increased costAttributable cost, $16,450$965-31,937
        Retrospective cohortTertiary careBSI K. pneumoniae 46/82aMortalityORc for death in cases, 2.661.07-6.59 76
    LOSCases, 22 days; controls, 16 days P = 0.03
        Prospective cohortTertiary careBSI E. coli 46/308aMortalityOR for death in cases, 3.571.48-8.60 47
    Studies showing no impact of resistance
        Case-controlTertiary careNosocomial Enterobacteriaceae 23/174MortalityCases, 26%; controls, 16% P = 0.14 18
        Case-controlTertiary careNosocomial K. pneumoniae 60/60a, dMortalityCases, 30%; controls, 28.3% P = 0.0841 33
        Case-controlTertiary careNosocomialEnterobacteriaceae31/39MortalityCases, 3.0%; controls, 2.4% P > 0.05 13
        Case-controlTertiary careBSI E. coli and 35/105aLOSCases, 8.2 additional days P = 0.182 84
    Klebsiella spp.
        Retrospective cohortTertiary careNosocomial K. pneumoniae 68/75aMortalityRRe, 0.940.45-1.97 28
        Prospective cohortMulticenterBSI or pneumonia Enterobacteriaceae 135/40MortalityCases, 5.2%; controls, 12.5% P = 0.15 4
    • ↵ a Studies with either matched controls or multivariate analysis, in order to minimize confounding.

    • ↵ b CAPD, continuous ambulatory peritoneal dialysis.

    • ↵ c OR, odds ratio.

    • ↵ d Matched controls.

    • ↵ e RR, risk ratio.

  • TABLE 3.

    Prevalence of MDR among P. aeruginosa strains in various parts of the world

    RegionPeriodSettingResistance (%)Reference
    North America
        United States2001ICU/non-ICU9.1/7.0 35
        United States2002ICU14 35
        United States2003Nosocomial infections9.9 36
    South America, 10 sites1997-1999Nosocomial infections8.2 24
    Europe
        12 to 23 sites1997-1999Nosocomial infections4.7 24
        33 ICUs1997-2000ICU3-50 29
    Asia/Pacific
        17 sites1997-1999Nosocomial infections1.6 24
        Japan2001Nosocomial infections2.8 74
        Malaysia2005Nosocomial infections6.9 62
  • TABLE 4.

    Impact of the MDR phenotype in P. aeruginosa on mortality, LOS, and hospital cost

    Type of studySettingInfectionNo. of cases/no. of controlsParameterMain findingsSignificance (P value or 95% CI)Reference
    Studies showing an impact of resistance
        Case-controlTertiary careNosocomial69/247MortalityOR,a 5.01.1-22.9 31
        Retrospective cohortTertiary careNosocomial44/68b, cMortalityCases, 54.5%; controls, 16.2% P < 0.05 11
        Case-controlTertiary careBSI6/184b, cMortalityCases, 83.3%; controls, 36.4% P = 0.03 34
        ProspectiveTertiary careNosocomial/98/103MortalityRR, 1.981.0-3.9 41
        ProspectiveTertiary careNosocomial86/212cMortalityRR, 1.601.2-2.1d 85
        Retrospective matched cohortTertiary careNosocomial82/82b, c, eMortalityOR, 4.4 P = 0.04 1
    Retrospective cohort study showing no impact of resistanceTertiary careNoscomial18/35c, fMortalityCases, 22%; controls, 23% P > 0.05 53
    • ↵ a OR, odds ratio.

    • ↵ b MDR was defined as resistance to four or more antibiotics.

    • ↵ c Studies with either matched controls or multivariate analysis, in order to minimize confounding.

    • ↵ d Not significant in multivariate analysis.

    • ↵ e Matched controls.

    • ↵ f MDR was defined as resistance to two or more antibiotics.

  • TABLE 5.

    Prevalence of carbapenem resistance in Acinetobacter spp. in various parts of the world

    RegionPeriodSettingResistance (%)Reference
    ImipenemMeropenem
    North America
        15 centers2002-2004Nonduplicate clinical isolates8.36.5 78
        24 centers2001Non-ICU isolates6.110.4 35
        15 centers2006All isolates3353 40
    South America
        25 centers2002-2004Nonduplicate clinical isolates28.128.5 78
        7 countries2001Nonduplicate clinical isolates16.318.1 73
    Europe
        48 centers2002-2004Nonduplicate clinical isolates30.226.9 78
        37 centers1997-2000Nonduplicate clinical isolates1614 77
    Asia/Pacific, 2 centers2002-2004Nonduplicate clinical isolates1.26.0 78
    Australia1999-2004Nonduplicate clinical isolates1111 78
  • TABLE 6.

    Impact of carbapenem resistance in Acinetobacter spp. on mortality, LOS, and hospital costs

    Type of study showing an impact of resistanceSettingInfectionNo. of cases/no. of controlsParameterMain findingsSignificance (P value or 95% CI)Reference
    Case-controlTertiary careNosocomial10/10MortalityCases, 34%; controls, 27% P > 0.05 9
    LOSCases, 31.5 days; controls, 13 days P = 0.02
    Case-controlTertiary careBurn patients34/43MortalityCases, 26.5%; controls, 0% P < 0.01 82
    LOSCases, 32.5 days; controls 21 days P < 0.01
    Case-controlTertiary careBurn patients34/183LOSCases, 36.8 days; controls, 25.6 days P = 0.06 81
    CostCases, $98,575 higher P < 0.01
    Case-controlTertiary careBSI40/40aMortalityCases, 57.5%; controls, 25.7% P = 0.007 39
    Case-controlICUNosocomial infections34/68aMortalityOR,b 3.91.4-10.7 61
    LOSCases, 30 days longer11-38 days
    Case-controlICUColonization32/63aLOS (ICU)Cases, 19 days longer5-28 days 61
    • ↵ a Studies with either matched controls or multivariate analysis, in order to minimize confounding.

    • ↵ b OR, odds ratio.

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Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli
Christian G. Giske, Dominique L. Monnet, Otto Cars, Yehuda Carmeli on behalf of ReAct-Action on Antibiotic Resistance
Antimicrobial Agents and Chemotherapy Feb 2008, 52 (3) 813-821; DOI: 10.1128/AAC.01169-07

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Clinical and Economic Impact of Common Multidrug-Resistant Gram-Negative Bacilli
Christian G. Giske, Dominique L. Monnet, Otto Cars, Yehuda Carmeli on behalf of ReAct-Action on Antibiotic Resistance
Antimicrobial Agents and Chemotherapy Feb 2008, 52 (3) 813-821; DOI: 10.1128/AAC.01169-07
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  • Top
  • Article
    • E. COLI AND K. PNEUMONIAE STRAINS RESISTANT TO EXTENDED-SPECTRUM CEPHALOSPORINS
    • MDR P. AERUGINOSA
    • CARBAPENEM-RESISTANT ACINETOBACTER SPP.
    • CONCLUSIONS
    • ACKNOWLEDGMENTS
    • REFERENCES
  • Figures & Data
  • Info & Metrics
  • PDF

KEYWORDS

Anti-Bacterial Agents
Drug Resistance, Multiple, Bacterial
Gram-negative bacteria
Gram-negative bacterial infections
length of stay

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