title: Risk factors and outcomes of infections caused by extremely drug-resistant gram-negative bacilli in patients hospitalized in intensive care units.
abstract: BACKGROUND
  Extremely drug-resistant gram-negative bacilli (XDR-GNB) increasingly cause health care-associated infections (HAIs) in intensive care units (ICUs).
  
  
  METHODS
  A matched case-control (1:2) study was conducted from February 2007 to January 2010 in 16 ICUs. Case and control subjects had HAIs caused by GNB susceptible to ≤1 antibiotic versus ≥2 antibiotics, respectively. Logistic and Cox proportional hazards regression assessed risk factors for HAIs and predictors of mortality, respectively.
  
  
  RESULTS
  Overall, 103 case and 195 control subjects were enrolled. An immunocompromised state (odds ratio [OR], 1.55; P = .047) and exposure to amikacin (OR, 13.81; P < .001), levofloxacin (OR, 2.05; P = .005), or trimethoprim-sulfamethoxazole (OR, 3.42; P = .009) were factors associated with XDR-GNB HAIs. Multiple factors in both case and control subjects significantly predicted increased mortality at different time intervals after HAI diagnosis. At 7 days, liver disease (hazard ratio [HR], 5.52), immunocompromised state (HR, 3.41), and bloodstream infection (HR, 2.55) predicted mortality; at 15 days, age (HR, 1.02 per year increase), liver disease (HR, 3.34), and immunocompromised state (HR, 2.03) predicted mortality; and, at 30 days, age (HR, 1.02 per 1-year increase), liver disease (HR, 3.34), immunocompromised state (HR, 2.03), and hospitalization in a medical ICU (HR, 1.85) predicted mortality.
  
  
  CONCLUSIONS
  HAIs caused by XDR-GNB were associated with potentially modifiable factors. Age, liver disease, and immunocompromised state, but not XDR-GNB HAIs, were associated with mortality.
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY. Electronic address: sameer.patel@northwestern.edu.
authors.forename: Sameer J
authors.initials: SJ
authors.lastname: Patel
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: André P
authors.initials: AP
authors.lastname: Oliveira
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: Juyan Julia
authors.initials: JJ
authors.lastname: Zhou
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: Luis
authors.initials: L
authors.lastname: Alba
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY; Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, NY.
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
authors.affiliation: Department of Medicine, Alta Bates Summit Medical Center, Oakland, CA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Weisenberg
authors.affiliation: Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY; School of Nursing, Columbia University Medical Center, New York, NY.
authors.forename: Haomiao
authors.initials: H
authors.lastname: Jia
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Clock
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY; Department of Pharmacy, New York-Presbyterian Hospital, New York, NY.
authors.forename: Christine J
authors.initials: CJ
authors.lastname: Kubin
authors.affiliation: Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Jenkins
authors.affiliation: Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY; Clinical Microbiology Laboratory, New York-Presbyterian Hospital, New York, NY.
authors.forename: Audrey N
authors.initials: AN
authors.lastname: Schuetz
authors.affiliation: Clinical Performance Improvement, University of Pennsylvania Health System, Philadelphia, PA.
authors.forename: Maryam
authors.initials: M
authors.lastname: Behta
authors.affiliation: Department of Pathology, Columbia University Medical Center, New York, NY.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Della-Latta
authors.affiliation: Department of Pathology, Columbia University Medical Center, New York, NY.
authors.forename: Susan
authors.initials: S
authors.lastname: Whittier
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, NY.
authors.forename: Kyu
authors.initials: K
authors.lastname: Rhee
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Infection Prevention & Control, New York-Presbyterian Hospital, New York, NY.
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
mesh_terms: D000151:Acinetobacter Infections / Q000401:mortality; D000293:Adolescent; D000367:Age Factors; D000368:Aged; D000583:Amikacin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents; D016022:Case-Control Studies; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae; D064704:Levofloxacin / Q000627:therapeutic use; D008107:Liver Diseases / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa; D012307:Risk Factors; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D000583:Amikacin
keywords: Antibiotic resistance; Gram-negative bacteria; Health care-associated infection; Mortality
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