March 29, 2020 Journal article Open Access

J.W. Timotëus Deelen; Jan Kluytmans; Anton Buiting; Wouter C. Rottier; Marc J. M. Bonten; Bart J. M. Vlaminckx; Steven F. T. Thijsen; Paul D. van der Linden; J. Wendelien Dorigo-Zetsma; Heidi S.M. Ammerlaan; Annemarie J. L. Weersink; Giorgia Caruana; Giorgia Caruana

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  <identifier identifierType="URL">https://www.openaccessrepository.it/record/83577</identifier>
  <creators>
    <creator>
      <creatorName>J.W. Timotëus Deelen</creatorName>
    </creator>
    <creator>
      <creatorName>Jan Kluytmans</creatorName>
    </creator>
    <creator>
      <creatorName>Anton Buiting</creatorName>
    </creator>
    <creator>
      <creatorName>Wouter C. Rottier</creatorName>
    </creator>
    <creator>
      <creatorName>Marc J. M. Bonten</creatorName>
    </creator>
    <creator>
      <creatorName>Bart J. M. Vlaminckx</creatorName>
    </creator>
    <creator>
      <creatorName>Steven F. T. Thijsen</creatorName>
    </creator>
    <creator>
      <creatorName>Paul D. van der Linden</creatorName>
    </creator>
    <creator>
      <creatorName>J. Wendelien Dorigo-Zetsma</creatorName>
    </creator>
    <creator>
      <creatorName>Heidi S.M. Ammerlaan</creatorName>
    </creator>
    <creator>
      <creatorName>Annemarie J. L. Weersink</creatorName>
    </creator>
    <creator>
      <creatorName>Giorgia Caruana</creatorName>
    </creator>
    <creator>
      <creatorName>Giorgia Caruana</creatorName>
    </creator>
  </creators>
  <titles>
    <title>Attributable mortality of antibiotic resistance in Gram-negative infections in the Netherlands: a parallel matched cohort study</title>
  </titles>
  <publisher>INFN Open Access Repository</publisher>
  <publicationYear>2020</publicationYear>
  <subjects>
    <subject>Netherlands</subject>
    <subject>Infectious Diseases</subject>
    <subject>Microbiology (medical)</subject>
    <subject>General Medicine</subject>
  </subjects>
  <dates>
    <date dateType="Issued">2020-03-29</date>
  </dates>
  <language>en</language>
  <resourceType resourceTypeGeneral="Text">Journal article</resourceType>
  <alternateIdentifiers>
    <alternateIdentifier alternateIdentifierType="url">https://www.openaccessrepository.it/record/83577</alternateIdentifier>
  </alternateIdentifiers>
  <relatedIdentifiers>
    <relatedIdentifier relatedIdentifierType="DOI" relationType="IsIdenticalTo">10.1016/j.cmi.2020.07.014</relatedIdentifier>
    <relatedIdentifier relatedIdentifierType="URL" relationType="IsPartOf">https://www.openaccessrepository.it/communities/itmirror</relatedIdentifier>
  </relatedIdentifiers>
  <rightsList>
    <rights rightsURI="https://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution 4.0</rights>
    <rights rightsURI="info:eu-repo/semantics/openAccess">Open Access</rights>
  </rightsList>
  <descriptions>
    <description descriptionType="Abstract">Abstract Objectives Antibiotic resistance in Gram-negative bacteria has been associated with increased mortality. This was demonstrated mostly for third-generation cephalosporin-resistant (3GC-R) Enterobacterales bacteraemia in international studies. Yet, the burden of resistance specifically in the Netherlands and created by all types of Gram-negative infection has not been quantified. We therefore investigated the attributable mortality of antibiotic resistance in Gram-negative infections in the Netherlands. Methods In eight hospitals, a sample of Gram-negative infections was identified between 2013 and 2016, and separated into resistant and susceptible infection cohorts. Both cohorts were matched 1:1 to non-infected control patients on hospital, length of stay at infection onset, and age. In this parallel matched cohort set-up, 30-day mortality was compared between infected and non-infected patients. The impact of resistance was then assessed by dividing the two separate risk ratios (RRs) for mortality attributable to Gram-negative infection. Results We identified 1,954 Gram-negative infections, of which 1,190 (61%) involved Escherichia coli, 210 (11%) Pseudomonas aeruginosa, and 758 (39%) bacteraemia. Resistant Gram-negatives caused 243 infections (12%; 189 (78%) 3GC-R Enterobacterales, 9 (4%) multidrug-resistant P. aeruginosa, no carbapenemase-producing Enterobacterales). Subsequently, we matched 1,941 non-infected controls. After adjustment, point estimates for RRs comparing mortality between infections and controls were similarly higher than 1 in case of resistant infections and susceptible infections (1.42 (95% confidence interval 0.66-3.09) and 1.32 (1.06-1.65), respectively). By dividing these, the RR reflecting attributable mortality of resistance was calculated as 1.08 (0.48-2.41). Conclusions In the Netherlands, antibiotic resistance did not increase 30-day mortality in Gram-negative infections.</description>
  </descriptions>
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