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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  "doi": "10.1016/j.cmi.2020.07.014", 
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    "creators": [
      {
        "name": "J.W. Timot\u00ebus Deelen"
      }, 
      {
        "name": "Jan Kluytmans"
      }, 
      {
        "name": "Anton Buiting"
      }, 
      {
        "name": "Wouter C. Rottier"
      }, 
      {
        "name": "Marc J. M. Bonten"
      }, 
      {
        "name": "Bart J. M. Vlaminckx"
      }, 
      {
        "name": "Steven F. T. Thijsen"
      }, 
      {
        "name": "Paul D. van der Linden"
      }, 
      {
        "name": "J. Wendelien Dorigo-Zetsma"
      }, 
      {
        "name": "Heidi S.M. Ammerlaan"
      }, 
      {
        "name": "Annemarie J. L. Weersink"
      }, 
      {
        "name": "Giorgia Caruana"
      }, 
      {
        "name": "Giorgia Caruana"
      }
    ], 
    "description": "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.", 
    "doi": "10.1016/j.cmi.2020.07.014", 
    "keywords": [
      "Netherlands", 
      "Infectious Diseases", 
      "Microbiology (medical)", 
      "General Medicine"
    ], 
    "language": "eng", 
    "license": {
      "id": "CC-BY-4.0"
    }, 
    "notes": "", 
    "publication_date": "2020-03-29", 
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    }, 
    "resource_type": {
      "subtype": "article", 
      "title": "Journal article", 
      "type": "publication"
    }, 
    "title": "Attributable mortality of antibiotic resistance in Gram-negative infections in the Netherlands: a parallel matched cohort study"
  }, 
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    14
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