Risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in Intensive Care Unit, HUSM

Objectives: Carbapenem-resistant (CR) Gram-negative pathogens have increased substantially and is worrisome. This study was performed to identify the risk factors for development as well as outcomes of CR Gram-negative bacteremia (GNB) among patients in Intensive Care Unit (ICU), Hospital Universiti...

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Main Author:	Aziz, Rozila
Format:	Thesis
Language:	English
Published:	2015
Subjects:	RA Public aspects of medicine
Online Access:	http://eprints.usm.my/40800/1/Dr._Rozila_Aziz-24_pages.pdf
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spelling	my-usm-ep.408002020-03-25T09:55:50Z Risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in Intensive Care Unit, HUSM 2015-05 Aziz, Rozila RA Public aspects of medicine Objectives: Carbapenem-resistant (CR) Gram-negative pathogens have increased substantially and is worrisome. This study was performed to identify the risk factors for development as well as outcomes of CR Gram-negative bacteremia (GNB) among patients in Intensive Care Unit (ICU), Hospital Universiti Sains Malaysia (HUSM). Methods: Retrospective, case-control study; risk factors for development of CR-GNB were investigated using two groups of patients: the first group (control) consisted of patients who acquired carbapenem susceptible (CS) GNB and the second group (case) included patients with CRGNB. The case groups were compared to the control group defined as patients hospitalized in the ICU during the same period, with similar inclusion and exclusion criterias. 96 cases of Gram-negative bacilli BSI from ICU were randomly selected and their medical record were traced from Record Office and reviewed. Their demographic profiles, underlying diseases, potential risk factors, antibiotic usage, microbiology results and outcome were reviewed. Results: Total 96 patients were included for the study, 48 patients with CR- were compared to 48 patients with CS-GNB. Increased length of ICU stay (OR 2.09, 95 % CI 1.01–33.18, p=0.019), DM (OR 3.5, 95 % CI 1.61–13.24, p =0.016), presence of tracheostomy and chest drain (OR 5.17, 95% CI 1.94 – 18.92, p=0.010) and (OR 5.79, 95% CI, 4.27 – 24.40, p = 0.016) respectively, prior exposure to carbapenems (OR 5.90, 95% CI, 4.63 – 7.40, p= 0.002) and those who have infected by Acinetobacter baumannii (OR 6.18, 95% CI, 2.56 – 8.68, p = 0.010) and Pseudomonas aeruginosa (OR 4.29, 95% CI, 0.22 – 8.48, p = 0.034) were independent risk factors associated with CR-GNB. Crude mortality in CS-GNB was greater compared to CR group, however, statistically not significant (p = 0.679). Meanwhile, the attributable mortality in CR-GNB was noted higher than CS-GNB (24 patients in CR compared to 17 patients in CS-GNB), with p=0.011. Conclusions: This study indicates the importance of preventing CR-GNB blood stream infections and the appropriate use of antimicrobial agents to reduce attributable mortality. 2015-05 Thesis http://eprints.usm.my/40800/ http://eprints.usm.my/40800/1/Dr._Rozila_Aziz-24_pages.pdf application/pdf en public masters Universiti Sains Malaysia Pusat Pengajian Sains Perubatan
institution	Universiti Sains Malaysia
collection	USM Institutional Repository
language	English
topic	RA Public aspects of medicine
spellingShingle	RA Public aspects of medicine Aziz, Rozila Risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in Intensive Care Unit, HUSM
description	Objectives: Carbapenem-resistant (CR) Gram-negative pathogens have increased substantially and is worrisome. This study was performed to identify the risk factors for development as well as outcomes of CR Gram-negative bacteremia (GNB) among patients in Intensive Care Unit (ICU), Hospital Universiti Sains Malaysia (HUSM). Methods: Retrospective, case-control study; risk factors for development of CR-GNB were investigated using two groups of patients: the first group (control) consisted of patients who acquired carbapenem susceptible (CS) GNB and the second group (case) included patients with CRGNB. The case groups were compared to the control group defined as patients hospitalized in the ICU during the same period, with similar inclusion and exclusion criterias. 96 cases of Gram-negative bacilli BSI from ICU were randomly selected and their medical record were traced from Record Office and reviewed. Their demographic profiles, underlying diseases, potential risk factors, antibiotic usage, microbiology results and outcome were reviewed. Results: Total 96 patients were included for the study, 48 patients with CR- were compared to 48 patients with CS-GNB. Increased length of ICU stay (OR 2.09, 95 % CI 1.01–33.18, p=0.019), DM (OR 3.5, 95 % CI 1.61–13.24, p =0.016), presence of tracheostomy and chest drain (OR 5.17, 95% CI 1.94 – 18.92, p=0.010) and (OR 5.79, 95% CI, 4.27 – 24.40, p = 0.016) respectively, prior exposure to carbapenems (OR 5.90, 95% CI, 4.63 – 7.40, p= 0.002) and those who have infected by Acinetobacter baumannii (OR 6.18, 95% CI, 2.56 – 8.68, p = 0.010) and Pseudomonas aeruginosa (OR 4.29, 95% CI, 0.22 – 8.48, p = 0.034) were independent risk factors associated with CR-GNB. Crude mortality in CS-GNB was greater compared to CR group, however, statistically not significant (p = 0.679). Meanwhile, the attributable mortality in CR-GNB was noted higher than CS-GNB (24 patients in CR compared to 17 patients in CS-GNB), with p=0.011. Conclusions: This study indicates the importance of preventing CR-GNB blood stream infections and the appropriate use of antimicrobial agents to reduce attributable mortality.
format	Thesis
qualification_level	Master's degree
author	Aziz, Rozila
author_facet	Aziz, Rozila
author_sort	Aziz, Rozila
title	Risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in Intensive Care Unit, HUSM
title_short	Risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in Intensive Care Unit, HUSM
title_full	Risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in Intensive Care Unit, HUSM
title_fullStr	Risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in Intensive Care Unit, HUSM
title_full_unstemmed	Risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in Intensive Care Unit, HUSM
title_sort	risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in intensive care unit, husm
granting_institution	Universiti Sains Malaysia
granting_department	Pusat Pengajian Sains Perubatan
publishDate	2015
url	http://eprints.usm.my/40800/1/Dr._Rozila_Aziz-24_pages.pdf
_version_	1747820825083379712

Risk factors and outcomes of carbapenem-resistant gram negative bloodstream infection in Intensive Care Unit, HUSM

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