Methods: Hospitalized patients with laboratory confirmation of infection with each of four pathogens were identified in electronic health records from Premier Healthcare Alliance database. Two cohorts (Resistant and Susceptible) were identified based on antibiotic susceptibility data. The primary outcome measured was all-cause in-hospital mortality. We investigated the impact of each pathogen on patients by each isolated site (Respiratory, Blood, Urine and Other). A logistic regression was used to analyze the association of in-house mortality and CR infection in all 16 bacteria/specimen site cohorts with and without adjusting for the following potential confounders: age, gender, race, Charlson comorbidity index score, admission source, and admission type.
Results: From 2009 to 2013, CR was identified in 44.8 % (2,915/6,507) of all A. baumannii infections; 14.1% (7,994/56,517) of all P. aeruginosa infections; 3.6% (2,025/56,552) of all K. pneumoniae; 0.2% (328/173,200) of all E. coli infections. In-hospital mortality was greater in most of the CR pathogens groups than CS pathogens groups: especially for A. baumanniiinfection with blood stream isolate (crude OR = 3.91, 95% CI: 2.69-5.70). This effect remained after adjusting for the relevant confounders (adjusted OR=2.47, 95%CI: 1.43-4.22). In addition to CR, Mechanical Ventilation (all 16 models), Renal Impairment (9 models), Malignancy (11 models) and Mild liver disease (11 models) were also significantly associated with the in-hospital mortality with p-value <0.05.
Conclusion: CR infections of A. baumannii and P. aeruginosa were more frequently detected in blood and respiratory sites. Patients with CR of A. baumannii blood infection had higher odds of in-hospital mortality, even after adjusting for potential confounders. These results highlighted the need of development of novel agents for CR infections.
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J. C. Arjona Ferreira, SHIONOGI INC: Employee , Salary
M. Ariyasu, SHIONOGI & CO., LTD.: Employee , Salary
T. Sawada, SHIONOGI & CO., LTD.: Employee , Salary
R. Echols, SHIONOGI INC.: Consultant , Consulting fee
T. D. Nagata, SHIONOGI & CO., LTD.: Employee , Salary
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