التفاصيل البيبلوغرافية
| العنوان: |
Prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections among patients in an ICU. |
| المؤلفون: |
Souza de Oliveira, Ana Beatriz, Hirassawa Sacillotto, Guilherme, Balthazar Neves, Manuela Francisco, Nora da Silva, Andressa Hellen, Adriane Moimaz, Tamiris, Villafanha Gandolfi, Joelma, Lelles Nogueira, Mara Correa, Margareth Lobo, Suzana |
| المصدر: |
Brazilian Journal of Pulmonology / Jornal Brasileiro de Pneumologia; jan/feb2023, Vol. 49 Issue 1, p1-6, 6p |
| مصطلحات موضوعية: |
RESPIRATORY infections, MULTIDRUG-resistant tuberculosis, METHICILLIN-resistant staphylococcus aureus, CARBAPENEM-resistant bacteria, VENTILATOR-associated pneumonia, LENGTH of stay in hospitals |
| مستخلص: |
Objective: To determine the prevalence, outcomes, and predictors of multidrug-resistant nosocomial lower respiratory tract infections (LRTI) in patients in an ICU. Methods: This was an observational cohort study involving patients with nosocomial LRTI (health care-associated pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia). Data were prospectively collected between 2015 and 2019. The multidrugresistant pathogens (MDRPs) identified in the isolates studied included resistant to extended-spectrum cephalosporin-resistant and carbapenem-resistant Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa, carbapenem-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus aureus at microbiological diagnosis. Results: During the study period, 267 patients in the ICU were diagnosed with LRTI, microbiological confirmation of LRTI having been obtained in 237. Of these, 146 (62%) had at least one MDRP isolate. Patients infected with MDRP were found to have poorer outcomes than patients infected with susceptible strains, such as prolonged mechanical ventilation (18.0 days vs. 12.0 days; p < 0.001), prolonged ICU length of stay (23.0 days vs.16.0 days; p < 0.001), and higher mortality (73% vs. 53%; p < 0.001) when compared with patients infected with susceptible strains. Hospital length of stay ≥ 5 days (OR = 3.20; 95% CI: 1.39-7.39; p = 0.005) and prolonged use vasoactive drugs (OR = 3.15; 95% CI: 1.42-7.01; p = 0.004) were independent predictors of LRTI caused by MDRPs (LRTI-MDRP). The presence of LRTI-MDRP was found to be an independent predictor of death (OR = 2.311; 95% CI: 1.091-4.894; p = 0.028). Conclusions: Prolonged use of vasoactive drugs and prolonged hospital length of stay were independent predictors of LRTI-MDRP in this population of critically ill patients with very poor outcomes. [ABSTRACT FROM AUTHOR] |
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