title: Resistance patterns and outcomes in intensive care unit (ICU)-acquired pneumonia. Validation of European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms.
abstract: BACKGROUND
  Bacterial resistance has become a major public health problem.
  
  
  OBJECTIVE
  To validate the definition of multidrug-resistant organisms (MDRO) based on the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification.
  
  
  METHODS
  Prospective, observational study in six medical and surgical Intensive-Care-Units (ICU) of a University hospital.
  
  
  RESULTS
  Three-hundred-and-forty-three patients with ICU-acquired pneumonia (ICUAP) were prospectively enrolled, 140 patients had no microbiological confirmation (41%), 82 patients (24%) developed ICUAP for non-MDRO, whereas 121 (35%) were MDROs. Non-MDRO, MDRO and no microbiological confirmation patients did not present either a significant different previous antibiotic use (p 0.18) or previous hospital admission (p 0.17). Appropriate antibiotic therapy was associated with better ICU survival (105 [92.9%] vs. 74 [82.2%]; p = 0.03). An adjusted multivariate regression logistic analysis identified that only MDRO had a higher ICU-mortality than non-MDRO and no microbiological confirmation patients (OR 2.89; p < 0.05; 95% CI for Exp [β]. 1.02-8.21); Patients with MDRO ICUAP remained in ICU for a longer period than MDRO and no microbiological confirmation respectively (p < 0.01) however no microbiological confirmation patients had more often antibiotic consumption than culture positive ones.
  
  
  CONCLUSIONS
  Patients who developed ICUAP due to MDRO showed a higher ICU-mortality than non-MDRO ones and use of ICU resources. No microbiological confirmation patients had more often antibiotic consumption than culture positive patients. Risk factors for MDRO may be important for the selection of initial antimicrobial therapy, in addition to local epidemiology.
authors.affiliation: St. James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland; Critical Care Center, Corporacion Sanitaria Parc Taulí, CIBER Enfermedades Respiratorias, Parc Tauli, University Institute, Sabadell, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Martin-Loeches
authors.affiliation: Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain. Electronic address: ATORRES@clinic.ub.es.
authors.forename: Antonio
authors.initials: A
authors.lastname: Torres
authors.affiliation: Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain.
authors.forename: Mariano
authors.initials: M
authors.lastname: Rinaudo
authors.affiliation: Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Terraneo
authors.affiliation: Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain.
authors.forename: Francesca
authors.initials: F
authors.lastname: de Rosa
authors.affiliation: Intensive Care Medicine, Hospital Universitari i Politècnic la Fe, CIBER Enfermedades Respiratorias, Valencia, Spain.
authors.forename: Paula
authors.initials: P
authors.lastname: Ramirez
authors.affiliation: Critical Care Center, Corporacion Sanitaria Parc Taulí, CIBER Enfermedades Respiratorias, Parc Tauli, University Institute, Sabadell, Spain.
authors.forename: Emili
authors.initials: E
authors.lastname: Diaz
authors.affiliation: Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Fernández-Barat
authors.affiliation: Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain.
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Li Bassi
authors.affiliation: Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Ferrer
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002487:Centers for Disease Control and Prevention, U.S.; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents
keywords: Appropriate antibiotic treatment; Intensive care; MDR; MDROs; Pneumonia; Sepsis; VAP