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Impact de la multirésistance aux antibiotiques sur la mortalité et la durée de séjour dans des bactériémies nosocomiales et associées aux soins

Sujets: Articles en ligne

Lye DC; Earnest A; Ling ML; LeeTE; Yong HC; Fisher DA; et al. The impact of multidrug resistance in healthcare-associated and nosocomial gram-negative bacteraemia on mortality and length of stay: cohort study. Clinical microbiology and infection, 2011.

 

Mots-clés : BACTERIEMIE; ANTIBIORESISTANCE; MULTIRESISTANCE; MORTALITE;  DUREE  DE SEJOUR; ETUDE RETROSPECTIVE; COHORTE; ANALYSE MULTIVARIEE; FACTEUR DE RISQUE; ANTIBIOTIQUE; TRAITEMENT; BACILLE GRAM NEGATIF; ACINETOBACTER BAUMANNII; PSEUDOMONAS AERUGINOSA; ENTEROBACTERIE; BETA-LACTAMASE A SPECTRE ELARGI

 

Résumé:

Multidrug-resistant Gram-negative bacteria (MDR-GNB) are an emerging public health threat. Accurate estimates of their clinical impact are vital for justifying interventions directed towards preventing or managing infections caused by these pathogens. A retrospective observational cohort study was conducted between 1st January 2007 and 31st July 2009, involving subjects with healthcare-associated and nosocomial Gram-negative bacteraemia at two large Singaporean hospitals. Outcomes studied were mortality and length of stay in survivors (LOS). There were 675 subjects (301 with MDR-GNB) matching study inclusion criteria. On multivariate analysis, multidrug resistance was not associated with 30-day mortality, but it was independently associated with longer LOS in survivors (Coefficient:0.34, 95%CI:0.21 – 0.48, p<0.001). The excess LOS attributable to multidrug resistance after adjustment for confounders was 6.1 days. Other independent risk factors for higher mortality included male gender, higher APACHE II score, higher Charlson comorbidity index, intensive care unit stay and presence of concomitant pneumonia. Concomitant urinary tract infection and admission to a surgical discipline were associated with lower risk of mortality. Appropriate empirical antibiotic therapy was neither associated with 30-day mortality nor LOS, although the study was not powered to assess this covariate adequately. Our study adds to existing evidence that multidrug resistance per se is not associated with higher mortality when effective antibiotics are used for definitive therapy. However, its association with longer hospitalisation lends justification towards control efforts.

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Pour suivre les publications sur les infections nosocomiales : NosoVeille

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