Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels

Håkan Hanberger, Massimo Antonelli, Martin Holmbom, Jeffrey Lipman, Peter Pickkers, Marc Leone, Jordi Rello, Yasser Sakr, Sten M. Walther, Philippe Vanhems, Jean Louis Vincent, H. Betsch, B. Fogh, K. Espersen, K. Jacobsen, P. Berezowicz, V. Harjola, E. Sofianos, A. Armaganidis, C. RoutsiM. Bitzani, A. Chalkiadaki, A. Michalopoulos, E. Mouloudi, E. Ioannidou, P. Myrianthefs, D. Koulenti, I. Karampela, G. Kyriazopoulos, K. Mandragos, P. Clouva-molyvdas, A. Moraiti, I. Pneumatikos, K. Filos, E. Zakynthinos, A. Kotanidou, A. Vakalos, C. Sprung, A. Lev, E. Kishinevsky, J. Cohen, S. Sofer, S. Vesconi, S. Greco, M. Borelli, P. Cecilia, M. Sapuppo, A. Lazzero, V. Mangani, N. Petrucci, M. Minerva, E. De blasio, S. Marzorati, R. Rosi, A. Giarratano, O. Margarit, A. Guberti, S. Scolz, E. Stelian, V. Emmi, M. Caspani, A. Rosano, C. Abbruzzese, S. Colonna, R. Ceriani, R. De Blasi, L. Panella, F. Borrelli, P. Lorella, H. Ruatti, C. Munch, C. Sorbara, G. Fiore, A. Chieregato, V. Conti, A. Guadagnucci, M. Pizzamiglio, M. Locicero, I. Marri, A. Sicignano, V. Conte, R. Oggioni, A. De Gasperi, P. De Negri, G. Santagostino, R. Fumagalli, G. Marino, G. Castiglione, D. Sforza, N. Giuseppe, M. Bassetti, F. Ferraro, S. Clementi, D. Alessandro, P. Cotogni, MV Ranieri, M. Antonelli, L. Martinelli, L. Gianesello, A. Gullo, A. Morelli, G. Biancofiore, G. Della Rocca, M. Borg, A. De Pont, P. Rosseel, J. Ten Cate, G. Van Berkel, S. Corsten, J. Bakker, J. Vogelaar, H. Blom, H. Kieft, M. Kuiper, A. Gille, P. Pickkers, J. Vet, J. Ammann, S. Den Boer, R. Wesselink, B. Speelberg, C. Pham, M. Rodgers, D. Bergmans, J. Groeneveld, R. Loevstad, P. Klepstad, P. Erno, A. Junker, A. Bártolo, M. Castelo-Branco Sousa, F. Esteves, A. Martins, T. Oliveira, P. Ponce, L. Mourão, C. Febra, E. Carmo, V. Lopes, P. Póvoa, A. Rezende, H. Costa, P. Moreira, F. Pádua, A. Leite, E. Almeida, M. Alves, A. Sousa, L. Telo, C. Dias, J. Paiva, R. Ribeiro, P. Amaro, A. Carneiro, R. Moreno, Ricardo Matos, Susana Afonso, M. Bouw, C. França, O. Rubio, R. Mañez, Burgueño Campiñez, M. Alvarez, R. Jorda, E. Naveira-Abeigón, P. Monedero, E. Alemparte-Pardavila, S. Garcia del Valle, C. Perez Calvo, M. Palomar, F. Guerrero, A. Caballero Zirena, M. Arribas, E. Bustamante Munguira, J. Ruiz, L. Iglesias, E. Zavala, M. Valencia, A. Blesa Malpica, F. Martinez-Sagasti, M. Nieto, G. Aguilar, F. Martinon-Torres, C. Lorente, J. Insausti, R. Vegas Pinto, I. Santos, A. Escriba, P. Olaechea, E. Muñoz, E. Antón Caraballo, P. Galdos-Anuncibay, V. Lopez Camps, F. Esteban-Reboll, A. Estella, L. Bocero, A. Ibañez, L. Pueyo, L. María Jesús, L. Iglesias, J. Silva, P. Garro, L. Ramos-gómez, A. Rovira, M. Martin Delgado, J. Monton Dito, F. Garcia, J. Navarro, J. Latour-Perez, A. Albaya, A. Bustinza, J. Sole-violán, P. Ugarte Peña, I. Yuste, J. De Rojas Román, J. Vallés, E. Esteban, E. Quintana Tort-Martorell, M. Moreno, V. López Ciudad, A. Manzano Ramirez, J. Sánchez-Olmedo, M. Borges, J. Amador Amerigo, F. Guerrero Gomez, J. Montejo González, J. Sirvent, E. Mesalles Sanjuan, F. Barcenilla-Gaite, N. Serrano, E. Cerdá, A. Lesmes Serrano, C. Garcia-Fuentes, J. Macias Pingarrón, E. Espinosa, M. Sanchez Garcia, F. Felices, M. de la Torre-Prados, H. Maria Jesus, V. Luis, R. Jara, M. Briones Lopez, P. Posada, B. Galvan, F. Mariscal, J. Rello, B. Gil, R. Sierra, J. Rico-Feijoo, C. Corcobado Márquez, J. Izura, J. González, J. Soto Ibáñez, P. Petersen, L. Johansson, H. Blomqvist, B. Peterzén, N. Wyon, H. Stiernstrom, I. Lindström, A. Paulsson, C. Agvald-Ohman, J. Petersson, H. Friberg, V. Einar, F. Hammarskjöld, M. Schindele, S. Arvidsson, J. Sellgren, J. Hulting, J. Häggqvist, J. Rudenstam, D. Lind, E. Kokinsky, A. Owall, S. Jacobson, A. Nydahl, K. Atalan, C. Ates, A. Kahveci, H. Fistikci, A. Kaya, E. Ozgencil, M. Kizilkaya, M. Bosnak, H. Bodur, M. Akan, M. Guven, M. Turkoglu, A. Topeli, T. Togal, N. Uzel, I. Akinci, N. Cakar, S. Tugrul, O. Demirkiran, T. Adanir, K. Dogruer, A. Turkmen, H. Guven, F. Ulger, S. Kocak

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance.Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of ≥ 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of <5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden).Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P <0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P <0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P <0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections.Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome.

Original languageEnglish
Article number513
JournalBMC Infectious Diseases
Volume14
Issue number1
DOIs
Publication statusPublished - Sep 22 2014

Keywords

  • Antibiotic
  • Critically ill
  • Infection
  • Resistance

ASJC Scopus subject areas

  • Infectious Diseases
  • Medicine(all)

Fingerprint Dive into the research topics of 'Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels'. Together they form a unique fingerprint.

Cite this