Article Figures & Data
Tables
- TABLE 1.
Prevalence of resistance to extended-spectrum cephalosporins in E. coli and K. pneumoniae in various parts of the world
Region Period Setting Resistance (%) Reference K. pneumoniae E. coli North America United States 2003 ICU 20.6 5.8 50 United States 2004 Intra-abdominal infections 5.3 2.8 63 United States (Brooklyn) 2006 All infections 59 40 Latin America Seven countries 2000 Urinary tract infections 22.3 3.1 25 Ten countries 2004 Intra-abdominal infections 27.6 12.0 63 Europe Northern Europe 2000-2001 Nosocomial infections 5.2 1.4 7 Southern Europe 2000-2001 Nosocomial infections 25.7 6.6 7 Nine countries 2004 Intra-abdominal infections 8.8 6.4 63 Asia China 1998-2002 Nosocomial infections 37.3 31.3 30 Japan 1998-2002 Nosocomial infections 11.0 6.5 30 Singapore 1998-2002 Nosocomial infections 36.4 12.3 30 Oceania (Australia) 1998-2002 Nosocomial infections 4.6 1.6 30 South Africa 1998-2002 Nosocomial infections 29.6 1.9 30 - TABLE 2.
Impact of extended-spectrum cephalosporin resistance in Enterobacteriaceae on mortality, LOS, and hospital cost
Type of study Setting Type of infection Bacteria No. of cases/no. of controls Parameter Main findings Significance (P value or 95% CI) Reference Studies showing an impact of resistance Case-control Tertiary care Nosocomial E. coli and K. pneumoniae 33/66a LOS Cases, 1.76 times greater duration 1.17-2.64 42 Increased cost Cases, 2.90 times higher cost 1.76-4.78 Case-control Tertiary care BSI K. pneumoniae 44/118a LOS Cases, 39.6 days; controls, 23.9 days P < 0.008 38 Case-control Multicenter Nosocomial K. pneumoniae 9/9 Mortality Cases, 44%; controls, 33% P > 0.05 9 LOS Cases, 37 ± 25 days; controls, 15 ± 10 days P = 0.04 Case-control Tertiary care Peritonitis (CAPDb) E. coli 11/77 Mortality Cases, 27.3%; controls, 3.9% P = 0.02 83 Retrospective cohort Tertiary care BSI Enterobacteriaceae 99/99a LOS Cases, 1.56 greater duration P = 0.001 68 Increased cost Cases, 1.57 times higher cost P = 0.003 Retrospective cohort Tertiary care Non-urinary tract E. coli and Klebsiella spp. 21/21a Mortality Cases, 8%; controls, 14% P = 0.182 44 LOS Cases, 21 days; controls, 11 days P = 0.006 Increased cost Attributable cost, $16,450 $965-31,937 Retrospective cohort Tertiary care BSI K. pneumoniae 46/82a Mortality ORc for death in cases, 2.66 1.07-6.59 76 LOS Cases, 22 days; controls, 16 days P = 0.03 Prospective cohort Tertiary care BSI E. coli 46/308a Mortality OR for death in cases, 3.57 1.48-8.60 47 Studies showing no impact of resistance Case-control Tertiary care Nosocomial Enterobacteriaceae 23/174 Mortality Cases, 26%; controls, 16% P = 0.14 18 Case-control Tertiary care Nosocomial K. pneumoniae 60/60a, d Mortality Cases, 30%; controls, 28.3% P = 0.0841 33 Case-control Tertiary care Nosocomial Enterobacteriaceae 31/39 Mortality Cases, 3.0%; controls, 2.4% P > 0.05 13 Case-control Tertiary care BSI E. coli and 35/105a LOS Cases, 8.2 additional days P = 0.182 84 Klebsiella spp. Retrospective cohort Tertiary care Nosocomial K. pneumoniae 68/75a Mortality RRe, 0.94 0.45-1.97 28 Prospective cohort Multicenter BSI or pneumonia Enterobacteriaceae 135/40 Mortality Cases, 5.2%; controls, 12.5% P = 0.15 4 - TABLE 3.
Prevalence of MDR among P. aeruginosa strains in various parts of the world
Region Period Setting Resistance (%) Reference North America United States 2001 ICU/non-ICU 9.1/7.0 35 United States 2002 ICU 14 35 United States 2003 Nosocomial infections 9.9 36 South America, 10 sites 1997-1999 Nosocomial infections 8.2 24 Europe 12 to 23 sites 1997-1999 Nosocomial infections 4.7 24 33 ICUs 1997-2000 ICU 3-50 29 Asia/Pacific 17 sites 1997-1999 Nosocomial infections 1.6 24 Japan 2001 Nosocomial infections 2.8 74 Malaysia 2005 Nosocomial infections 6.9 62 - TABLE 4.
Impact of the MDR phenotype in P. aeruginosa on mortality, LOS, and hospital cost
Type of study Setting Infection No. of cases/no. of controls Parameter Main findings Significance (P value or 95% CI) Reference Studies showing an impact of resistance Case-control Tertiary care Nosocomial 69/247 Mortality OR,a 5.0 1.1-22.9 31 Retrospective cohort Tertiary care Nosocomial 44/68b, c Mortality Cases, 54.5%; controls, 16.2% P < 0.05 11 Case-control Tertiary care BSI 6/184b, c Mortality Cases, 83.3%; controls, 36.4% P = 0.03 34 Prospective Tertiary care Nosocomial/ 98/103 Mortality RR, 1.98 1.0-3.9 41 Prospective Tertiary care Nosocomial 86/212c Mortality RR, 1.60 1.2-2.1d 85 Retrospective matched cohort Tertiary care Nosocomial 82/82b, c, e Mortality OR, 4.4 P = 0.04 1 Retrospective cohort study showing no impact of resistance Tertiary care Noscomial 18/35c, f Mortality Cases, 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
Region Period Setting Resistance (%) Reference Imipenem Meropenem North America 15 centers 2002-2004 Nonduplicate clinical isolates 8.3 6.5 78 24 centers 2001 Non-ICU isolates 6.1 10.4 35 15 centers 2006 All isolates 33 53 40 South America 25 centers 2002-2004 Nonduplicate clinical isolates 28.1 28.5 78 7 countries 2001 Nonduplicate clinical isolates 16.3 18.1 73 Europe 48 centers 2002-2004 Nonduplicate clinical isolates 30.2 26.9 78 37 centers 1997-2000 Nonduplicate clinical isolates 16 14 77 Asia/Pacific, 2 centers 2002-2004 Nonduplicate clinical isolates 1.2 6.0 78 Australia 1999-2004 Nonduplicate clinical isolates 11 11 78 - TABLE 6.
Impact of carbapenem resistance in Acinetobacter spp. on mortality, LOS, and hospital costs
Type of study showing an impact of resistance Setting Infection No. of cases/no. of controls Parameter Main findings Significance (P value or 95% CI) Reference Case-control Tertiary care Nosocomial 10/10 Mortality Cases, 34%; controls, 27% P > 0.05 9 LOS Cases, 31.5 days; controls, 13 days P = 0.02 Case-control Tertiary care Burn patients 34/43 Mortality Cases, 26.5%; controls, 0% P < 0.01 82 LOS Cases, 32.5 days; controls 21 days P < 0.01 Case-control Tertiary care Burn patients 34/183 LOS Cases, 36.8 days; controls, 25.6 days P = 0.06 81 Cost Cases, $98,575 higher P < 0.01 Case-control Tertiary care BSI 40/40a Mortality Cases, 57.5%; controls, 25.7% P = 0.007 39 Case-control ICU Nosocomial infections 34/68a Mortality OR,b 3.9 1.4-10.7 61 LOS Cases, 30 days longer 11-38 days Case-control ICU Colonization 32/63a LOS (ICU) Cases, 19 days longer 5-28 days 61