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Observational Study
. 2018 Jul 31:7:93.
doi: 10.1186/s13756-018-0388-z. eCollection 2018.

Risk for subsequent infection and mortality after hospitalization among patients with multidrug-resistant gram-negative bacteria colonization or infection

Wen-Pin Tseng  1 , Yee-Chun Chen  2   3 , Shang-Yu Chen  1 , Shey-Ying Chen  1 , Shan-Chwen Chang  2
Affiliations
Observational Study

Risk for subsequent infection and mortality after hospitalization among patients with multidrug-resistant gram-negative bacteria colonization or infection

Wen-Pin Tseng et al. Antimicrob Resist Infect Control. .

Abstract

Background: Risks for subsequent multidrug-resistant gram-negative bacteria (MDRGNB) infection and long-term outcome after hospitalization among patients with MDRGNB colonization remain unknown.

Methods: This observational study enrolled 817 patients who were hospitalized in the study hospital in 2009. We defined MDRGNB as a GNB resistant to at least three different antimicrobial classes. Patients were classified into MDRGNB culture-positive (MDRGNB-CP; 125 patients) and culture-negative (MDRGNB-CN; 692 patients) groups based on the presence or absence of any MDRGNB identified from either active surveillance or clinical cultures during index hospitalization. Subsequent MDRGNB infection and mortality within 12 months after index hospitalization were recorded. We determined the frequency and risk factors for subsequent MDRGNB infection and mortality associated with previous MDRGNB culture status.

Results: In total, 129 patients had at least one subsequent MDRGNB infection (MDRGNB-CP, 48.0%; MDRGNB-CN, 10.0%), and 148 patients died (MDRGNB-CP, 31.2%; MDRGNB-CN, 15.9%) during the follow-up period. MDR Escherichia coli and Acinetobacter baumannii were the predominant colonization microorganisms; patients with Proteus mirabilis and Pseudomonas aeruginosa had the highest hazard risk for developing subsequent infection. After controlling for other confounders, MDRGNB-CP during hospitalization independently predicted subsequent MDRGNB infection (hazard ratio [HR], 5.35; 95% confidence interval [CI], 3.72-7.71), all-cause mortality (HR, 2.42; 95% CI, 1.67-3.50), and subsequent MDRGNB infection-associated mortality (HR, 4.88; 95% CI, 2.79-8.52) after hospitalization.

Conclusions: Harboring MDRGNB significantly increases patients' risk for subsequent MDRGNB infection and mortality after hospitalization, justifying the urgent need for developing effective strategies to prevent and eradicate MDRGNB colonization.

Keywords: Colonization; Gram-negative bacteria; Mortality; Multidrug resistance; Subsequent infection.

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Conflict of interest statement

The study was approved by the institutional review board of National Taiwan University Hospital and the requirement for written consent was waived.Not applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Kaplan–Meier curves at 1 year for a subsequent MDRGNB infection, b all-cause mortality, and c MDRGNB infection-associated mortality after discharge, stratified by index hospitalization MDRGNB culture result. Abbreviations: MDRGNB, multidrug-resistant gram-negative bacteria; MDRGNB-CN, multidrug-resistant gram-negative bacteria culture negative; MDRGNB-CP, multidrug-resistant gram-negative bacteria culture positive
Fig. 2
Fig. 2
Patient enrollment and classification flowchart. Abbreviations: OPD, outpatient department; MDRGNB, multidrug-resistant gram-negative bacteria; MDRGNB-CP, multidrug-resistant gram-negative bacteria culture positive; MDRGNB-CN, multidrug-resistant gram-negative bacteria culture negative
See this image and copyright information in PMC

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