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Risk factors and outcomes associated with the isolation of polymyxin B and carbapenem-resistant Enterobacteriaceae spp.: A case–control study.
- Source :
-
International Journal of Antimicrobial Agents . May2019, Vol. 53 Issue 5, p657-662. 6p. - Publication Year :
- 2019
-
Abstract
- • Polymyxin resistance was most common in carbapenem resistant Enterobacter spp. • Prior polymyxin and carbapenem exposures were predictors of polymyxin resistance. • Many polymyxin-resistant cases were detected in patients not exposed to polymyxins. Increasing resistance to polymyxin, a last-line antibiotic, is a growing public health concern worldwide. The primary objective of this study was to identify predictors for the isolation of polymyxin-resistant (PR) carbapenem-resistant Enterobacteriaceae (CRE) among hospitalized patients. The secondary objective was to describe the clinical outcomes of patients with PR-CRE infections. A retrospective case–control study including patients admitted to Singapore General Hospital between June 2012 and June 2016 was conducted. Cases were defined as patients who had clinical cultures from which a PR-CRE was isolated. Controls were randomly selected from patients with polymyxin-susceptible (PS) CRE admitted during the same period, and frequency-matched to site of isolation. We included 37 PR cases and 111 PS controls. Polymyxin resistance was detected predominantly in Enterobacter spp. (54.1%) and Klebsiella pneumoniae (43.2%). Multilocus sequence typing showed little clonal relatedness among the isolates. mcr-1 was detected in two PR-CRE isolates. Multivariable analyses showed that PR-CRE isolation was associated with prior polymyxins (adjusted odds ratio (OR), 21.31; 95% confidence interval (CI), 3.04–150.96) and carbapenem exposures (OR 3.74; CI 1.13–12.44), when adjusted for time at risk and bacteria species. In PR-CRE patients with infections, the 30-day all-cause in-hospital mortality was 50.0% as compared to 38.1% in patients with PS-CRE (P = 0.346). Prior polymyxin and carbapenem exposures were independent risk factors for isolation of PR-CRE. Outcomes of PR-CRE and PS-CRE infections were similar in this study. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 09248579
- Volume :
- 53
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- International Journal of Antimicrobial Agents
- Publication Type :
- Academic Journal
- Accession number :
- 136012506
- Full Text :
- https://doi.org/10.1016/j.ijantimicag.2019.03.011