| Risk factors associated with the isolation of colistin-resistant gram-negative bacteria: a matched case-control study. | |
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MedLine Citation:
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PMID: 18431267 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The emergence of multidrug-resistant gram-negative bacteria has led to the re-use of colistin, but resistance to this agent has already been reported. We aimed to investigate the potential risk factors for the isolation of colistin-resistant Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa from hospitalized patients. DESIGN: Matched case-control study. SETTING: Tertiary care hospital in Athens, Greece. PATIENTS: Case patients were those who had provided a clinical specimen from which a colistin-resistant K. pneumoniae, A. baumannii, or P. aeruginosa was isolated. Controls were selected from a pool of patients who had susceptible to colistin isolates and were matched (1:1) to cases for species of microorganism and site of isolation. Susceptibility to colistin was determined with the Etest. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data regarding patient demographics, comorbidities, admission to the intensive care unit, prior antibiotic use, and invasive procedures performed were analyzed as risk factors in a matched bivariable model. Variables significantly associated with colistin-resistant isolates (p < .05) were entered in a backward multivariable logistic regression model. Forty-one colistin-resistant unique patient isolates were identified from January 1, 2006, until March 31, 2007. These isolates represented infection in 35 of 41 patients. Risk factors significantly associated with the isolation of colistin-resistant isolates were age, duration of intensive care unit stay, [corrected] surgical procedures, use of colistin, use of monobactams, duration of use of colistin and duration of use of antifungal agents [corrected] In the multivariable model, use of colistin was identified as the only independent risk factor (adjusted odds ratio = 7.78, p = .002). CONCLUSIONS: Colistin-resistant K. pneumoniae, A. baumannii, and P. aeruginosa pathogens may be encountered in clinical practice, in association with inappropriate colistin use. To prevent this phenomenon, colistin should be used judiciously, given that treatment options for colistin-resistant gram-negative bacteria are limited. |
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Authors:
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Dimitrios K Matthaiou; Argyris Michalopoulos; Petros I Rafailidis; Drosos E Karageorgopoulos; Vassiliki Papaioannou; Georgia Ntani; George Samonis; Matthew E Falagas |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Critical care medicine Volume: 36 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2008 Mar |
Date Detail:
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Created Date: 2008-04-23 Completed Date: 2008-05-29 Revised Date: 2008-07-17 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 807-11 Citation Subset: AIM; IM |
Affiliation:
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Alfa Institute of Biomedical Sciences, Athens, Greece. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Acinetobacter baumannii
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drug effects*,
isolation & purification Aged Anti-Bacterial Agents / pharmacology* Case-Control Studies Colistin / pharmacology* Drug Resistance, Bacterial Female Humans Klebsiella pneumoniae / drug effects*, isolation & purification Male Middle Aged Pseudomonas aeruginosa / drug effects*, isolation & purification Retrospective Studies Risk Factors |
| Chemical | |
Reg. No./Substance:
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0/Anti-Bacterial Agents; 1066-17-7/Colistin |
| Comments/Corrections | |
Erratum In:
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Crit Care Med. 2008 Jul;36(7):2224 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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