Prior antibiotic use and acquisition of multidrug-resistant organisms in hospitalized children: A systematic review

2019 ◽  
Vol 40 (10) ◽  
pp. 1107-1115 ◽  
Author(s):  
Meghan T. Murray ◽  
Melissa P. Beauchemin ◽  
Natalie Neu ◽  
Elaine L. Larson
Keyword(s):  
Systematic Review ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Original Research ◽  
Hospitalized Children ◽  
Antibiotic Exposure ◽  
Risk Of Death ◽  
Increased Risk ◽  
Multidrug Resistant Organisms ◽  
The Impact

AbstractObjective:Multidrug-resistant organisms (MDROs) cause ~5%–10% of infections in hospitalized children, leading to an increased risk of death, prolonged hospitalization, and additional costs. Antibiotic exposure is considered a driving factor of MDRO acquisition; however, consensus regarding the impact of antibiotic factors, especially in children, is lacking. We conducted a systematic review to examine the relationship between antibiotic use and subsequent healthcare-associated infection or colonization with an MDRO in children.Design:Systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline.Methods:We searched PubMed and Embase for all English, peer-reviewed original research studies published before September 2018. Included studies evaluated hospitalized children, antibiotic use as an exposure, and bacterial MDRO as an outcome.Results:Of the 535 studies initially identified, 29 met the inclusion criteria. Overall, a positive association was identified in most studies evaluating a specific antibiotic exposure (17 of 21, 81%), duration of antibiotics (9 of 12, 75%), and number of antibiotics received (2 of 3, 67%). Those studies that evaluated any antibiotic exposure had mixed results (5 of 10, 50%). Study sites, populations, and definitions of antibiotic use and MDROs varied widely.Conclusions:Published studies evaluating this relationship are limited and are of mixed quality. Limitations include observation bias in recall of antibiotic exposure, variations in case definitions, and lack of evaluation of antibiotic dosing and appropriateness. Additional studies exploring the impact of antibiotic use and MDRO acquisition may be needed to develop effective antibiotic stewardship programs for hospitalized children.

scholarly journals Mortality in Patients With Septic Shock by Multidrug Resistant Bacteria

2017 ◽  
Vol 34 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Stefano Busani ◽  
Giulia Serafini ◽  
Elena Mantovani ◽  
Claudia Venturelli ◽  
Maddalena Giannella ◽  
...  
Keyword(s):  
Septic Shock ◽  
Statistical Significance ◽  
Multidrug Resistant ◽  
Immunoglobulin M ◽  
University Hospital ◽  
Resistant Bacteria ◽  
Sepsis Management ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background: Patients with septic shock by multidrug resistant (MDR) microorganism maybe considered a specific population of critical patients at very high risk of death in whom the effects of standard sepsis treatment has never been assessed. The objective of this retrospective analysis was to evaluate the risk factors for 30-day mortality and the impact of sepsis management in patients with septic shock caused by MDR bacteria. Methods: Patients with septic shock by MDR bacteria admitted to the mixed intensive care unit (ICU) of Modena University Hospital during a 6-year period were studied. The clinical and microbiological characteristics and sepsis treatments provided were analyzed and compared between survivors (S) and nonsurvivors (NS) at 30 days after septic shock appearance. Results: Ninety-four patients were studied. All therapeutic interventions applied to patients during their ICU stay did not show statistical significance between S and NS groups, except for administration of immunoglobulin M (IgM) preparation which were provided more frequently in S group ( P < .05). At the multivariate adjusted analysis, preexisting cancer (odds ratio [OR] = 2.965) and Acinetobacter baumannii infections (OR = 3.197) were independently correlated with an increased risk of 30-day mortality, whereas treatment with IgM preparation was protective (OR = 0.283). Conclusions: This retrospective study showed that in patients with septic shock caused by MDR bacteria, history of cancer and infection sustained by A baumannii increase the risk of mortality and that standard sepsis treatments do not seem to provide any protective effect. Adjunctive therapy with IgM preparation seems to be beneficial, but further appropriate studies are needed to confirm the results observed.

scholarly journals The Impact of Multidrug-Resistant Organisms Infection on Outcomes in Burn Injury Patients at Sanglah General Hospital, Bali

2021 ◽  
Vol 9 (A) ◽  
pp. 463-467
Author(s):  
Gede Wara Samsarga ◽  
I Made Suka Adnyana ◽  
Ni Nyoman Sri Budayanti ◽  
I Gusti Putu Hendra Sanjaya ◽  
Agus Roy Rusly Hariantana Hamid ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Length Of Stay ◽  
Antibiotic Therapy ◽  
General Hospital ◽  
Burn Injury ◽  
Multidrug Resistant ◽  
Burn Patients ◽  
Increased Risk ◽  
Multidrug Resistant Organisms ◽  
The Impact

BACKGROUND: Research related to the impact of multidrug resistant organisms (MDRO) infection on clinical outcomes in burns is still limited. AIM: This study evaluated the effect of MDRO infection on morbidity and mortality of burn patients. METHODS: A single-center retrospective cohort study was conducted on burn patients admitted to the burn unit of Sanglah General Hospital, Bali, between 2018 and 2020. MDRO patients were described as those who had at least one positive MDRO culture. All other patients were included in the non-MDRO group. Measurement and analysis included mortality and five indicators of morbidity: length of stay, duration of antibiotic therapy, sepsis, pneumonia, and acute kidney injury (AKI). RESULTS: Significant associations of MDRO infection were found for duration of antibiotic therapy (0 vs. 7 days), sepsis (odds ratio [OR] 13.90 [95% Confidence interval (CI) 95% 2.88–67.10]), pneumonia (OR 12,67 [95% CI 3.26–49.23]), and mortality (OR 9.75 [95% CI 2.00–47.50]). No significant association was found for the length of stay and the incidence of AKI. Multivariate analysis found that MDRO infection increased risk of sepsis (OR 36.53 [95% CI 2.05–652.45], pneumonia (OR 10.75 [95% CI 1.87–61.86]) and mortality (OR 57.09 [95% CI 1.41–2318.87]). Multivariate analysis of MDRO infection with duration of antibiotic therapy found no independent variables that were significantly related. CONCLUSION: These research findings suggest that MDRO infections are associated with increasing length of antibiotic treatment, sepsis, pneumonia, and mortality in burn patients.

scholarly journals A retrospective observational study of the impact of Tigecycline in treating multidrug resistant pneumonia

2017 ◽  
Vol 4 (3) ◽  
pp. 122
Author(s):  
John Paul ◽  
Cherish Paul
Keyword(s):  
Critically Ill ◽  
Meta Analysis ◽  
Multidrug Resistant ◽  
Health Concern ◽  
P Value ◽  
Global Public Health ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Few antimicrobials are currently active to treat extensively drug resistant (XDR) gram-negative bacilli infections. This represents a serious global public health concern. Critically ill patients face the brunt of majority of these infections. Tigecycline has coverage for a majority of these XDR infections (with the exception of <em>Pseudomonas aeruginosa</em>), but is not currently approved for hospital-acquired pneumonia. Nevertheless it is being commonly used for this indication though many meta-analysis have suggested an increased risk of death in patients receiving this antibiotic. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">In this retrospective analysis we compared the mortality rates between a Tigecycline based and a non Tigecycline based therapy for XDR infections in the critically ill over a period of 12 months. A total of 93 patients were included in the study.</span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Tigecycline group had significantly increased risk for in hospital mortality with an odds ratio of 6.0 and 95% CI of 1.37 to 26.12 with a p value of 0.01. But such a difference was not evident in 14 day mortality.  </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Initiation of Tigecycline for multidrug resistant, pneumonia needs to be re-thought. Only a small percentage of patients with pneumonia with <em>in-vitro</em> sensitivity having low minimum inhibitory concentration (MIC) would benefit from the drug. Even in this group the risk of increased mortality needs to be carefully considered before Initiation of therapy</span>.</p>

scholarly journals The Impact of Multidrug-Resistant Organisms on Outcomes in Patients With Diabetic Foot Infections

2020 ◽  
Vol 7 (5) ◽  
Author(s):  
Oryan Henig ◽  
Jason M Pogue ◽  
Emily Martin ◽  
Umar Hayat ◽  
Mahmoud Ja’ara ◽  
...  
Keyword(s):  
Propensity Score ◽  
Diabetic Foot ◽  
Medical Center ◽  
Conditional Logistic Regression ◽  
Generation Cephalosporin ◽  
Multidrug Resistant ◽  
Diabetic Foot Infections ◽  
Increased Risk ◽  
Multidrug Resistant Organisms ◽  
The Impact

Abstract Background Multidrug-resistant organisms (MDROs) are important diabetic foot infection (DFI) pathogens. This study evaluated the impact of DFIs associated with MDRO pathogens (DFI-MDRO) on clinical outcomes. Methods Adults admitted to Detroit Medical Center from January 2012 to December 2015 with culture-positive DFI were included. Associations between outcomes and DFI-MDRO (evaluated as a single group that included methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci, Enterobacteriaceae resistant to third-generation cephalosporin [3GCR-EC], Acinetobacter baumannii, and Pseudomonas aeruginosa) were analyzed. Outcomes included above- and below-knee lower extremity amputation (LEA), readmissions, and mortality within a year after DFI. A propensity score predicting the likelihood of having DFI-MDRO was computed by comparing patients with DFI-MDRO with patients with DFI with non-MDRO pathogens (DFI-non-MDRO). Using conditional logistic regression, DFI-MDRO was analyzed as an independent variable after patients in the MDRO and non-MDRO groups were matched by propensity score. Results Six hundred forty-eight patients were included, with a mean age ± SD of 58.4 ± 13.7. Most patients in the cohort presented with chronic infection (75%). DFI-MDRO occurred in greater than one-half of the cohort (n = 364, 56%), and MRSA was the most common MDRO (n = 224, 62% of the DFI-MDRO group). In propensity-matched analyses, DFI-MDRO was not associated with 1-year LEA or readmissions, but was associated with recurrent DFI episodes (odds ratio, 2.1; 95% confidence interval, 1.38–3.21). Conclusions DFI-MDRO was associated with a 2-fold increased risk of recurrent DFI compared with patients with DFI-non-MDRO.

scholarly journals Antibiotic use and colorectal neoplasia: a systematic review and meta-analysis

2021 ◽  
Vol 8 (1) ◽  
pp. e000601
Author(s):  
Chino Aneke-Nash ◽  
Garrett Yoon ◽  
Mengmeng Du ◽  
Peter Liang
Keyword(s):  
Systematic Review ◽  
Gut Microbiome ◽  
Colorectal Neoplasia ◽  
Meta Analysis ◽  
Early Adulthood ◽  
Final Analysis ◽  
Antibiotic Use ◽  
Antibiotic Exposure ◽  
Exposure Effect ◽  
Increased Risk

Background and aimsColorectal cancer (CRC) is the third most common cancer for women and men and the second leading cause of cancer death in the USA. There is emerging evidence that the gut microbiome plays a role in CRC development, and antibiotics are one of the most common exposures that can alter the gut microbiome. We performed a systematic review and meta-analysis to characterise the association between antibiotic use and colorectal neoplasia.MethodsWe searched PubMed, EMBASE, and Web of Science for articles that examined the association between antibiotic exposure and colorectal neoplasia (cancer or adenoma) through 15 December 2019. A total of 6031 citations were identified and 6 papers were included in the final analysis. We assessed the association between the level of antibiotic use (defined as number of courses or duration of therapy) and colorectal neoplasia using a random effects model.ResultsSix studies provided 16 estimates of the association between level of antibiotic use and colorectal neoplasia. Individuals with the highest levels of antibiotic exposure had a 10% higher risk of colorectal neoplasia than those with the lowest exposure (effect size: 1.10, 95% CI 1.01 to 1.18). We found evidence of high heterogeneity (I2=79%, p=0.0001) but not of publication bias.ConclusionsHigher levels of antibiotic exposure is associated with an increased risk of colorectal neoplasia. Given the widespread use of antibiotics in childhood and early adulthood, additional research to further characterise this relationship is needed.

Impact of Different Methods for Describing the Extent of Prior Antibiotic Exposure on the Association Between Antibiotic Use and Antibiotic-Resistant Infection

2007 ◽  
Vol 28 (6) ◽  
pp. 647-654 ◽  
Author(s):  
Emily P. Hyle ◽  
Warren B. Bilker ◽  
Leanne B. Gasink ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Antibiotic Use ◽  
Continuous Variable ◽  
Antibiotic Exposure ◽  
Categorical Variable ◽  
Antibiotic Resistant ◽  
E Coli ◽  
Multivariable Models ◽  
The Impact

Objective.Many studies have investigated the association between prior antibiotic use and antibiotic resistance. However, methods used in past studies to describe the extent of prior antibiotic use (eg, use of the 2 categories exposure versus no exposure and measurement of duration of exposure) have not been reviewed. The impact of the use of different methods for quantifying the use of antibiotics is unknown. The objectives of this study were to characterize past approaches to describing the extent of antibiotic use and to identify the impact of the use of different methods on associations between use of specific antibiotics and infection with an antibiotic-resistant-organism.Methods.We conducted a systematic review of studies that investigated risk factors for extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species to identify variability in past approaches to describing the extent of antibiotic use. We then reanalyzed a data set from a prior study of risk factors for infection with ESBL-producing E. coli and Klebsiella species. We developed 2 separate multivariable models: 1 in which prior antibiotic use was described as a categorical variable (eg, exposure or no exposure) and 1 in which antibiotic use was described as a continuous variable (eg, measured in antibiotic-days). These models were compared qualitatively.Setting.Large academic medical center.Results.The 25 articles included in the systematic review revealed a variety of methods used to describe the extent of prior antibiotic exposure. Only 1 study justified its approach. Results from the 2 multivariable models that used different methodologic approaches differed substantially. Specifically, use of third-generation cephalosporins was a risk factor for infection with ESBL-producing E. coli and Klebsiella species when antibiotic use was described as a continuous variable but not when antibiotic use was described as a categorical variable.Conclusions.There has been no consistent method for assessing the extent of prior antibiotic exposure. The use of different methods may substantially alter the identified antimicrobial risk factors, which has important implications for the resultant interventions regarding antimicrobial use.

scholarly journals Characterization of Antibiotic Use, Documented Infection and Prevalence of Multidrug-Resistant Organisms in Palliative Care Patients Admitted to a Private Hospital in Brazil: A Retrospective, Cohort Study

2021 ◽  
Vol 0 ◽  
pp. 1-8
Author(s):  
Mara Graziele Maciel ◽  
Mayra Fruitg ◽  
Rebeca Pissolati Lawall ◽  
Alexandre Toledo Maciel
Keyword(s):  
Palliative Care ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Hospital Stay ◽  
Private Hospital ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Documented Infection ◽  
Multidrug Resistant Organisms ◽  
The Impact

Objectives: Antibiotic use in palliative care patients is a frequent dilemma. The benefits of their use in terms of quality of end-of-life care or survival improvement are not clear and the potential harm and futility of this practice not well established. Our aim was to characterise the prevalence of antibiotic use, documented infection and multidrug-resistant organisms (MDROs) colonisation among palliative care patients admitted to a private hospital in Brazil. Materials and Methods: Retrospective analysis of all palliative care patients admitted to our hospital during 1 year, including demographic characteristics, diagnosis of infectious disease at admission, antibiotic use during hospital stay, infectious agents isolated in cultures, documented MDRO colonisation and hospital mortality. Results: A total of 114 patients were included in the analysis. Forty-five (39%) were male and the median age was 83 years. About 78% of the patients had an infectious diagnosis at hospital admission and 80% of the patients not admitted with an infectious diagnosis used antibiotics during their stay, out of which a great proportion of large spectrum antibiotics. Previous MDRO colonisation and hospital mortality were similar between patients admitted with or without an infectious diagnosis. Conclusion: Infection is the leading cause of hospital admission in palliative care patients. However, antibiotics prescription is also very prevalent during hospital stay of patients not admitted with an infectious condition. Mortality is very high regardless of the initial reason for hospital admission. Therefore, the impact of multiple large spectrum antibiotics prescription and consequent significant cost burden should be urgently confronted with the real benefit to these patients.

Use of Longitudinal Surveillance Data to Assess the Effectiveness of Infection Control in Critical Care

2009 ◽  
Vol 30 (11) ◽  
pp. 1109-1112 ◽  
Author(s):  
John W. Ahern ◽  
W. Kemper Alston
Keyword(s):  
Infection Control ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Surveillance Data ◽  
Simple Method ◽  
Academic Medical ◽  
Multidrug Resistant Organisms ◽  
The Impact

A simple method for quantifying nosocomial infection and colonization with multidrug-resistant organisms is described. This method is applied to the intensive care unit of an academic medical center where longitudinal surveillance data have been used to assess the impact of infection control interventions and antibiotic use.

The impact of antibiotic allergy labels on antibiotic exposure, clinical outcomes, and healthcare costs: A systematic review

2020 ◽  
pp. 1-19
Author(s):  
Nathan M. Krah ◽  
Trahern W. Jones ◽  
Joanita Lake ◽  
Adam L. Hersh
Keyword(s):  
Systematic Review ◽  
Clinical Outcomes ◽  
Healthcare Costs ◽  
Healthcare Delivery ◽  
Antibiotic Use ◽  
Economic Outcomes ◽  
Inpatient Setting ◽  
Antibiotic Exposure ◽  
Antibiotic Allergy ◽  
The Impact

Abstract Objective: A growing body of evidence suggests that antibiotic allergy labels as documented in medical records are a risk factor for poor clinical outcomes. In this systematic review, we aimed to determine how antibiotic allergy labels influence 3 domains: antibiotic use and exposure, clinical outcomes, and healthcare-related costs. Design: We performed a systematic review to identify studies reporting outcomes in patients with antibiotic allergy labels compared to nonallergic counterparts. The search included PubMed, EMBASE, Cochrane CENTRAL, EBSCO, Cochrane Database of Abstracts of Reviews of Effects and Web of Science. Two reviewers independently screened studies for inclusion and abstracted data. Studies were graded using the Newcastle-Ottawa quality assessment scale. Study outcomes included antibiotic use, clinical outcomes, and economic outcomes. Results: In total, 41 studies met our criteria for inclusion. These studies varied in medical specialty, patient population, healthcare delivery system, and design, but most were conducted among adults age >18 years (85%) in the inpatient setting (82.5%). Among 34 studies examining antibiotic exposure, 32 (94%) found that patients with antibiotic allergy labels received more broad-spectrum antibiotics. Moreover, 31 studies examined clinical outcomes such as length of hospitalization, ICU admission, hospital readmission, multidrug-resistant or opportunistic infection, or mortality, and 27 (87%) found that allergy-labeled patients had at least 1 negative outcome. Of 9 studies examining healthcare costs, 7 (78%) found that allergy-labeled patients incurred significantly higher drug or hospital-related costs. Conclusions: Antibiotic allergy labels have negative effects on antibiotic use, clinical outcomes, and economic outcomes in a variety of clinical settings and populations.

scholarly journals Prenatal antibiotic exposure and childhood asthma: a population-based study

2018 ◽  
Vol 52 (1) ◽  
pp. 1702070 ◽  
Author(s):  
Keely Loewen ◽  
Barret Monchka ◽  
Salaheddin M. Mahmud ◽  
Geert 't Jong ◽  
Meghan B. Azad
Keyword(s):  
Childhood Asthma ◽  
Cox Regression ◽  
Antibiotic Use ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Antibiotic Exposure ◽  
Physician Billing ◽  
Increased Risk ◽  
Before And After ◽  
The Impact

Antibiotic use during infancy alters gut microbiota and immune development and is associated with an increased risk of childhood asthma. The impact of prenatal antibiotic exposure is unclear. We sought to characterise the association between prenatal antibiotic exposure and childhood asthma.We performed a population-based cohort study using prescription records, hospitalisation records and physician billing claims from 213 661 mother–child dyads born in Manitoba, Canada between 1996 and 2012. Associations were determined using Cox regression, adjusting for maternal asthma, postnatal antibiotics and other potential confounders. Sensitivity analyses evaluated maternal antibiotic use before and after pregnancy.36.8% of children were exposed prenatally to antibiotics and 10.1% developed asthma. Prenatal antibiotic exposure was associated with an increased risk of asthma (adjusted hazard ratio (aHR) 1.23, 95% CI 1.20–1.27). There was an apparent dose response (aHR 1.15, 95% CI 1.11–1.18 for one course; aHR 1.26, 95% CI 1.21–1.32 for two courses; and aHR 1.51, 95% CI 1.44–1.59 for three or more courses). Maternal antibiotic use during 9 months before pregnancy (aHR 1.27, 95% CI 1.24–1.31) and 9 months postpartum (aHR 1.32, 95% CI 1.28–1.36) were similarly associated with asthma.Prenatal antibiotic exposure was associated with a dose-dependent increase in asthma risk. However, similar associations were observed for maternal antibiotic use before and after pregnancy, suggesting the association is either not directly causal, or not specific to pregnancy.

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