A Novel Algorithm to Analyze Epidemiology and Outcomes of Carbapenem Resistance Among Patients With Hospital-Acquired and Ventilator-Associated Pneumonia: A Retrospective Cohort Study.

MedStar author(s):
Citation: Chest. 155(6):1119-1130, 2019 06.PMID: 30685333Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Algorithms | *beta-Lactam Resistance | *Carbapenems/pd [Pharmacology] | *Gram-Negative Bacteria | *Gram-Negative Bacterial Infections | *Healthcare-Associated Pneumonia | *Pneumonia, Ventilator-Associated | Costs and Cost Analysis | Female | Gram-Negative Bacteria/de [Drug Effects] | Gram-Negative Bacteria/ip [Isolation & Purification] | Gram-Negative Bacterial Infections/di [Diagnosis] | Gram-Negative Bacterial Infections/dt [Drug Therapy] | Gram-Negative Bacterial Infections/ec [Economics] | Gram-Negative Bacterial Infections/mo [Mortality] | Healthcare-Associated Pneumonia/dt [Drug Therapy] | Healthcare-Associated Pneumonia/ec [Economics] | Healthcare-Associated Pneumonia/mi [Microbiology] | Healthcare-Associated Pneumonia/mo [Mortality] | Humans | Length of Stay/sn [Statistics & Numerical Data] | Male | Middle Aged | Outcome and Process Assessment, Health Care/mt [Methods] | Pneumonia, Ventilator-Associated/dt [Drug Therapy] | Pneumonia, Ventilator-Associated/ec [Economics] | Pneumonia, Ventilator-Associated/mi [Microbiology] | Pneumonia, Ventilator-Associated/mo [Mortality] | Retrospective Studies | Survival Analysis | United States/ep [Epidemiology]Year: 2019Local holdings: Available online from MWHC library: 1935 - present, Available in print through MWHC library: 1999 - 2006ISSN:
  • 0012-3692
Name of journal: ChestAbstract: BACKGROUND: Carbapenem resistance is a growing concern. Applying a novel algorithm, we examined epidemiology and outcomes of carbapenem resistance among gram-negative pathogens in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP).CONCLUSIONS: Using administrative data, our novel algorithm identified patients with pneumonia at high risk for death, consistent with HAP/VAP. Among them, carbapenem resistance occurred in 12% of all cases and was associated with substantial excess in hospital costs.Copyright (c) 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.METHODS: In a retrospective cohort design within the Premier Research database (2009-2016), all hospitalized adult patients with a gram-negative organism in a respiratory or blood culture specimen who fit criteria for HAP/VAP based on International Classification of Diseases, Ninth Revision, Clinical Modification, codes were included in the study.RESULTS: Among 8,969 patients with HAP/VAP, 1,059 isolates (11.8%) were carbapenem-resistant (CR) organisms. Patients with CR organisms were more likely female (41.4% vs 33.2%; P < .001) and medical admissions (33.8% vs 27.4%, P < .001) than those with carbapenem-susceptible (CS) organisms. Patients with carbapenem resistance had higher comorbidity burden than those with carbapenem susceptibility (median [interquartile range] Charlson Comorbidity Index score, 3 [1-4] vs 2 [1-4]; P < .001). Pseudomonas aeruginosa was the most common gram-negative pathogen overall (24.9%) and among CS organisms (23.5%), and was second to Stenotrophomonas maltophilia (44.0%) among CR organisms (35.3%). Acinetobacter baumannii accounted for 11.8% of CR organisms and 2.5% of CS organisms (P < .001). Patients with carbapenem resistance were more likely than those with carbapenem susceptibility to receive inappropriate empiric therapy (25.8% vs 10.0%; P < .001). Carbapenem resistance did not affect adjusted mortality (22.9% CR vs 21.6% CS) or postinfection length of stay (except among survivors of VAP), but it was associated with excess costs (All authors: Fan W, Nathanson BH, Shorr AF, Sulham K, Zilberberg MDOriginally published: Chest. 2019 Jan 24Fiscal year: FY2019Digital Object Identifier: Date added to catalog: 2019-03-14
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30685333 Available 30685333

Available online from MWHC library: 1935 - present, Available in print through MWHC library: 1999 - 2006

BACKGROUND: Carbapenem resistance is a growing concern. Applying a novel algorithm, we examined epidemiology and outcomes of carbapenem resistance among gram-negative pathogens in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP).

CONCLUSIONS: Using administrative data, our novel algorithm identified patients with pneumonia at high risk for death, consistent with HAP/VAP. Among them, carbapenem resistance occurred in 12% of all cases and was associated with substantial excess in hospital costs.

Copyright (c) 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

METHODS: In a retrospective cohort design within the Premier Research database (2009-2016), all hospitalized adult patients with a gram-negative organism in a respiratory or blood culture specimen who fit criteria for HAP/VAP based on International Classification of Diseases, Ninth Revision, Clinical Modification, codes were included in the study.

RESULTS: Among 8,969 patients with HAP/VAP, 1,059 isolates (11.8%) were carbapenem-resistant (CR) organisms. Patients with CR organisms were more likely female (41.4% vs 33.2%; P < .001) and medical admissions (33.8% vs 27.4%, P < .001) than those with carbapenem-susceptible (CS) organisms. Patients with carbapenem resistance had higher comorbidity burden than those with carbapenem susceptibility (median [interquartile range] Charlson Comorbidity Index score, 3 [1-4] vs 2 [1-4]; P < .001). Pseudomonas aeruginosa was the most common gram-negative pathogen overall (24.9%) and among CS organisms (23.5%), and was second to Stenotrophomonas maltophilia (44.0%) among CR organisms (35.3%). Acinetobacter baumannii accounted for 11.8% of CR organisms and 2.5% of CS organisms (P < .001). Patients with carbapenem resistance were more likely than those with carbapenem susceptibility to receive inappropriate empiric therapy (25.8% vs 10.0%; P < .001). Carbapenem resistance did not affect adjusted mortality (22.9% CR vs 21.6% CS) or postinfection length of stay (except among survivors of VAP), but it was associated with excess costs ( ,921; 95% CI, 3,864-13,977).

English

Powered by Koha