A prospective study of treatment of carbapenem-resistant Enterobacteriaceae infections and risk factors associated with outcome

Imagem de Miniatura
Arquivos
art_CARRILHO_A_prospective_study_of_treatment_of_carbapenemresistant_Enterobacteriaceae_2016.PDF (791.57 KB)
Citações na Scopus
43
Tipo de produção
article
Data de publicação
2016
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
BIOMED CENTRAL LTD
Autores
CARRILHO, Claudia M. D. de Maio
PEROZIN, Jamile S.
URBANO, Mariana Ragassi
CAMARGO, Carlos H.
GRION, Cintia M. C.
Citação
BMC INFECTIOUS DISEASES, v.16, article ID 629, 9p, 2016
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Background: To describe the clinical and microbiological data of carbapenem-resistant Enterobacteriaceae (CRE) infections, the treatment used, hospital-and infection-related mortality, and risk factors for death. Methods: A prospective cohort conducted from March 2011 to December 2012. Clinical, demographic, and microbiological data such as in vitro sensitivity, clonality, carbapenemase gene mortality related to infection, and overall mortality were evaluated. Data were analyzed using Epi Info version 7.0 (CDC, Atlanta, GA, USA) and SPSS (Chicago, IL, USA). Results: One hundred and twenty-seven patients were evaluated. Pneumonia, 52 (42 %), and urinary tract infections (UTI), 51 (40.2 %), were the most frequent sites of infection. The isolates were polyclonal; the Bla(KPC) gene was found in 75.6 % of isolates, and 27 % of isolates were resistant to colistin. Mortality related to infection was 34.6 %, and was higher among patients with pneumonia (61.4 %). Combination therapy was used in 98 (77.2 %), and monotherapy in 22.8 %; 96.5 % of them were UTI patients. Shock, age, and dialysis were independent risk factors for death. There was no difference in infection-related death comparing colistin-susceptible and colistin-resistant infections (p = 0.46); neither in survival rate comparing the use of combination therapy with two drugs or more than two drugs (p = 0.32). Conclusions: CRE infection mortality was higher among patients with pneumonia. Infections caused by colistin-resistant isolates did not increase mortality. The use of more than two drugs on combination therapy did not show a protective effect on outcome. The isolates were polyclonal, and the bla(KPC) gene was the only carbapenemase found. Shock, dialysis, and age over 60 years were independent risk factors for death.
Palavras-chave
Enterobacteriaceae, Drug resistance, Multiple, Bacterial, Carbapenems, Colistin
URI
https://observatorio.fm.usp.br/handle/OPI/17083
Referências
  1. Adler A, 2011, MBIO, V2, DOI 10.1128/mBio.00280-11
  2. Bradford PA, 2004, CLIN INFECT DIS, V39, P55, DOI 10.1086/421495
  3. Bulik CC, 2011, ANTIMICROB AGENTS CH, V55, P3002, DOI 10.1128/AAC.01420-10
  4. Capone A, 2013, CLIN MICROBIOL INFEC, V19, pE23, DOI 10.1111/1469-0691.12070
  5. Ceccarelli G, 2013, ANTIMICROB AGENTS CH, V57, P2900, DOI 10.1128/AAC.00188-13
  6. CHARLSON ME, 1987, J CHRON DIS, V40, P373, DOI 10.1016/0021-9681(87)90171-8
  7. Chen Y, 2011, J ANTIMICROB CHEMOTH, V66, P1255, DOI 10.1093/jac/dkr082
  8. Cicora F, 2013, TRANSPL P, V45, P3389, DOI 10.1016/j.transproceed.2013.07.064
  9. Correa L, 2013, BMC INFECT DIS, V13, DOI 10.1186/1471-2334-13-80
  10. Daikos GL, 2014, ANTIMICROB AGENTS CH, V58, P2322, DOI 10.1128/AAC.02166-13
  11. de Oliveira MS, 2015, CLIN MICROBIOL INFEC, V21, DOI 10.1016/j.cmi.2014.07.010
  12. Grundmann H, 2010, EUROSURVEILLANCE, V15, P1
  13. Horan TC, 2008, AM J INFECT CONTROL, V36, P309, DOI 10.1016/j.ajic.2008.03.002
  14. Humphries RM, 2010, J MED MICROBIOL, V59, P1383, DOI 10.1099/jmm.0.023010-0
  15. Institute CLS, 2012, M100S20 CLSI
  16. Kontopidou F, 2014, CLIN MICROBIOL INFEC, V20, pO117, DOI 10.1111/1469-0691.12341
  17. Lee GC, 2012, ANN CLIN MICROB ANTI, V11, DOI 10.1186/1476-0711-11-32
  18. Levy MM, 2003, CRIT CARE MED, V31, P1250, DOI 10.1097/01.CCM.0000050454.01978.3B
  19. Marchaim D, 2011, INFECT CONT HOSP EP, V32, P861, DOI 10.1086/661597
  20. Mezzatesta ML, 2011, CLIN MICROBIOL INFEC, V17, P1444, DOI 10.1111/j.1469-0691.2011.03572.x
  21. Monteiro J, 2012, J ANTIMICROB CHEMOTH, V67, P906, DOI 10.1093/jac/dkr563
  22. Munoz-Price LS, 2013, LANCET INFECT DIS, V13, P785, DOI 10.1016/S1473-3099(13)70190-7
  23. Nordmann P, 2009, LANCET INFECT DIS, V9, P228, DOI 10.1016/S1473-3099(09)70054-4
  24. Pfaller MA, 1993, CLIN MICROBIOLOGY PR
  25. Qureshi ZA, 2012, ANTIMICROB AGENTS CH, V56, P2108, DOI 10.1128/AAC.06268-11
  26. Souli M, 2010, CLIN INFECT DIS, V50, P364, DOI 10.1086/649865
  27. Tumbarello M, 2015, J ANTIMICROB CHEMOTH, V70, P2133, DOI 10.1093/jac/dkv086
  28. van Duin D, 2013, DIAGN MICR INFEC DIS, V75, P115, DOI 10.1016/j.diagmicrobio.2012.11.009
  29. Zarkotou O, 2011, CLIN MICROBIOL INFEC, V17, P1798, DOI 10.1111/j.1469-0691.2011.03514.x

Coleções
Artigos e Materiais de Revistas Científicas - FM/MIP
Artigos e Materiais de Revistas Científicas - LIM/54
Artigos e Materiais de Revistas Científicas - ODS/03