Aziz, Rozila
(2015)
Risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in Intensive Care Unit, HUSM.
Masters thesis, Universiti Sains Malaysia.
Abstract
Objectives: Carbapenem-resistant (CR) Gram-negative pathogens have increased substantially and is worrisome. This study was performed to identify the risk factors for development as well as outcomes of CR Gram-negative bacteremia (GNB) among patients in Intensive Care Unit (ICU), Hospital Universiti Sains Malaysia (HUSM).
Methods: Retrospective, case-control study; risk factors for development of CR-GNB were investigated using two groups of patients: the first group (control) consisted of patients who acquired carbapenem susceptible (CS) GNB and the second group (case) included patients with CRGNB. The case groups were compared to the control group defined as patients hospitalized in the ICU during the same period, with similar inclusion and exclusion criterias. 96 cases of Gram-negative bacilli BSI from ICU were randomly selected and their medical record were traced from Record Office and reviewed. Their demographic profiles, underlying diseases, potential risk factors, antibiotic usage, microbiology results and outcome were reviewed.
Results: Total 96 patients were included for the study, 48 patients with CR- were compared to 48 patients with CS-GNB. Increased length of ICU stay (OR 2.09, 95 % CI 1.01–33.18, p=0.019), DM (OR 3.5, 95 % CI 1.61–13.24, p =0.016), presence of tracheostomy and chest drain (OR 5.17, 95% CI 1.94 – 18.92, p=0.010) and (OR 5.79,
95% CI, 4.27 – 24.40, p = 0.016) respectively, prior exposure to carbapenems (OR 5.90, 95% CI, 4.63 – 7.40, p= 0.002) and those who have infected by Acinetobacter baumannii (OR 6.18, 95% CI, 2.56 – 8.68, p = 0.010) and Pseudomonas aeruginosa (OR 4.29, 95% CI, 0.22 – 8.48, p = 0.034) were independent risk factors associated with CR-GNB.
Crude mortality in CS-GNB was greater compared to CR group, however, statistically not significant (p = 0.679). Meanwhile, the attributable mortality in CR-GNB was noted higher than CS-GNB (24 patients in CR compared to 17 patients in CS-GNB), with p=0.011.
Conclusions: This study indicates the importance of preventing CR-GNB blood stream infections and the appropriate use of antimicrobial agents to reduce attributable mortality.
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