Risk factors associated with the isolation of colistin-resistant Gram-negative bacteria: A matched case-control study

Matthaiou, DK; Michalopoulos, A; Rafailidis, PI; Karageorgopoulos, DE; Papaioannou, V; Ntani, G; Samonis, G; Falagas, ME

dc.contributor.author	Matthaiou, DK	en
dc.contributor.author	Michalopoulos, A	en
dc.contributor.author	Rafailidis, PI	en
dc.contributor.author	Karageorgopoulos, DE	en
dc.contributor.author	Papaioannou, V	en
dc.contributor.author	Ntani, G	en
dc.contributor.author	Samonis, G	en
dc.contributor.author	Falagas, ME	en
dc.date.accessioned	2014-03-01T01:29:05Z
dc.date.available	2014-03-01T01:29:05Z
dc.date.issued	2008	en
dc.identifier.issn	0090-3493	en
dc.identifier.uri	https://dspace.lib.ntua.gr/xmlui/handle/123456789/19128
dc.subject	Acinetobacter	en
dc.subject	Klebsiella	en
dc.subject	Mortality	en
dc.subject	Multiple drug resistance	en
dc.subject	Polymyxins	en
dc.subject	Pseudomonas	en
dc.subject.classification	Critical Care Medicine	en
dc.subject.other	cephalosporin derivative	en
dc.subject.other	colistin	en
dc.subject.other	monobactam derivative	en
dc.subject.other	Acinetobacter baumannii	en
dc.subject.other	adult	en
dc.subject.other	age distribution	en
dc.subject.other	aged	en
dc.subject.other	antibiotic resistance	en
dc.subject.other	antibiotic sensitivity	en
dc.subject.other	article	en
dc.subject.other	artificial ventilation	en
dc.subject.other	bacterial infection	en
dc.subject.other	bacterium isolation	en
dc.subject.other	clinical article	en
dc.subject.other	controlled study	en
dc.subject.other	drug use	en
dc.subject.other	female	en
dc.subject.other	human	en
dc.subject.other	intensive care unit	en
dc.subject.other	Klebsiella pneumoniae	en
dc.subject.other	length of stay	en
dc.subject.other	male	en
dc.subject.other	nonhuman	en
dc.subject.other	priority journal	en
dc.subject.other	Pseudomonas aeruginosa	en
dc.subject.other	risk factor	en
dc.subject.other	surgical technique	en
dc.title	Risk factors associated with the isolation of colistin-resistant Gram-negative bacteria: A matched case-control study	en
heal.type	journalArticle	en
heal.identifier.primary	10.1097/CCM.0B013E3181652FAE	en
heal.identifier.secondary	http://dx.doi.org/10.1097/CCM.0B013E3181652FAE	en
heal.language	English	en
heal.publicationDate	2008	en
heal.abstract	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, duration of mechanical ventilation, surgical procedures, use of colistin, use of monobactams, and duration of use of third-generation cephalosporins. 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. Copyright © 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.	en
heal.publisher	LIPPINCOTT WILLIAMS & WILKINS	en
heal.journalName	Critical Care Medicine	en
dc.identifier.doi	10.1097/CCM.0B013E3181652FAE	en
dc.identifier.isi	ISI:000253450500020	en
dc.identifier.volume	36	en
dc.identifier.issue	3	en
dc.identifier.spage	807	en
dc.identifier.epage	811	en