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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  <dc:creator>J.W. Timotëus Deelen</dc:creator>
  <dc:creator>Jan Kluytmans</dc:creator>
  <dc:creator>Anton Buiting</dc:creator>
  <dc:creator>Wouter C. Rottier</dc:creator>
  <dc:creator>Marc J. M. Bonten</dc:creator>
  <dc:creator>Bart J. M. Vlaminckx</dc:creator>
  <dc:creator>Steven F. T. Thijsen</dc:creator>
  <dc:creator>Paul D. van der Linden</dc:creator>
  <dc:creator>J. Wendelien Dorigo-Zetsma</dc:creator>
  <dc:creator>Heidi S.M. Ammerlaan</dc:creator>
  <dc:creator>Annemarie J. L. Weersink</dc:creator>
  <dc:creator>Giorgia Caruana</dc:creator>
  <dc:creator>Giorgia Caruana</dc:creator>
  <dc:date>2020-03-29</dc:date>
  <dc: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.</dc:description>
  <dc:identifier>https://www.openaccessrepository.it/record/83577</dc:identifier>
  <dc:identifier>10.1016/j.cmi.2020.07.014</dc:identifier>
  <dc:language>eng</dc:language>
  <dc:relation>url:https://www.openaccessrepository.it/communities/itmirror</dc:relation>
  <dc:rights>info:eu-repo/semantics/openAccess</dc:rights>
  <dc:rights>https://creativecommons.org/licenses/by/4.0/</dc:rights>
  <dc:subject>Netherlands</dc:subject>
  <dc:subject>Infectious Diseases</dc:subject>
  <dc:subject>Microbiology (medical)</dc:subject>
  <dc:subject>General Medicine</dc:subject>
  <dc:title>Attributable mortality of antibiotic resistance in Gram-negative infections in the Netherlands: a parallel matched cohort study</dc:title>
  <dc:type>info:eu-repo/semantics/article</dc:type>
  <dc:type>publication-article</dc:type>
</oai_dc:dc>