The Importance of Addressing Multidrug Resistance and Not Assuming Single-Drug Resistance in Case-Control Studies

2006 ◽  
Vol 27 (7) ◽  
pp. 670-674 ◽  
Author(s):  
Erika M. C. D'Agata ◽  
Maria Adriana Cataldo ◽  
Roberto Cauda ◽  
Evelina Tacconelli
Keyword(s):  
Risk Factors ◽  
Drug Resistance ◽  
Multidrug Resistant ◽  
Case Control ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Case Control Studies ◽  
Multidrug Resistant Bacteria ◽  
Single Drug ◽  
Independent Risk Factors

Background.Case-control studies analyzing antibiotic exposure as a risk factor for antimicrobial resistance usually assume single-drug resistance in the bacteria under study, even though resistance to multiple antimicrobials may be present. Since antibiotic selection pressures differ depending on the susceptibility profile of the antimicrobial-resistant bacteria, an accurate assessment of whether exposure to an individual antimicrobial is a risk factor for the emergence of resistance should distinguish between single-drug–resistant and multidrug-resistant bacteria.Objective.To determine whether the exposures to individual antibiotics that were identified as independent risk factors in case-control studies differed depending on whether single-drug–resistant or multidrug-resistant bacteria were evaluated.Design.Two retrospective case-control studies were performed with data on patients harboringPseudomonas aeruginosastrains resistant only to ciprofloxacin (CRPA) and patients harboringP. aeruginosastrains resistant to ciprofloxacin and other antibiotics (multidrug-resistantP. aeruginosa[MDR-PA]). These 2 groups were compared with patients not harboringP. aeruginosa.Setting.Two tertiary care hospitals.Results.A total of 41 patients harboring CRPA and 151 patients harboring MDR-PA were identified and matched to 192 control subjects. By conditional logistic regression, independent risk factors associated with presence of CRPA were nonambulatory status (OR, 5.6 [95% confidence interval {CI}, 1.4-23];P= .02) and prior ciprofloxacin exposure (OR, 5.0 [95% CI, 1.2-21];P= .03). Independent risk factors for presence of MDR-PA were a Charlson score greater than 2 (OR, 3.3 [95% CI 1.8-6.0];P<.001) and exposure to quinolones (OR, 2.8 [95% CI, 1.2-5.0];P= .001), third- and fourth-generation cephalosporins (OR, 3.5 [95% CI, 1.7-7.1];P<.001), imipenem (OR, 3.8 [95% CI, 1.2-12.1];P= .02), and/or aminoglycosides (OR, 2.3 [95% CI, 1.04-5.1];P= .04).Conclusion.There were substantial differences in exposure to individual antimicrobials between patients harboring CRPA and patients harboring MDR-PA. Future case-control studies addressing risk factors for single-drug–resistant bacteria should consider the complete susceptibility profile of the bacteria under investigation.

The Importance of Addressing Multidrug Resistance and Not Assuming Single-Drug Resistance in Case-Control Studies

2006 ◽  
Vol 27 (7) ◽  
pp. 670-674 ◽  
Author(s):  
Erika M. C. D'Agata ◽  
Maria Adriana Cataldo ◽  
Roberto Cauda ◽  
Evelina Tacconelli
Keyword(s):  
Risk Factors ◽  
Drug Resistance ◽  
Multidrug Resistant ◽  
Case Control ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Case Control Studies ◽  
Multidrug Resistant Bacteria ◽  
Single Drug ◽  
Independent Risk Factors

Background.Case-control studies analyzing antibiotic exposure as a risk factor for antimicrobial resistance usually assume single-drug resistance in the bacteria under study, even though resistance to multiple antimicrobials may be present. Since antibiotic selection pressures differ depending on the susceptibility profile of the antimicrobial-resistant bacteria, an accurate assessment of whether exposure to an individual antimicrobial is a risk factor for the emergence of resistance should distinguish between single-drug–resistant and multidrug-resistant bacteria.Objective.To determine whether the exposures to individual antibiotics that were identified as independent risk factors in case-control studies differed depending on whether single-drug–resistant or multidrug-resistant bacteria were evaluated.Design.Two retrospective case-control studies were performed with data on patients harboringPseudomonas aeruginosastrains resistant only to ciprofloxacin (CRPA) and patients harboringP. aeruginosastrains resistant to ciprofloxacin and other antibiotics (multidrug-resistantP. aeruginosa[MDR-PA]). These 2 groups were compared with patients not harboringP. aeruginosa.Setting.Two tertiary care hospitals.Results.A total of 41 patients harboring CRPA and 151 patients harboring MDR-PA were identified and matched to 192 control subjects. By conditional logistic regression, independent risk factors associated with presence of CRPA were nonambulatory status (OR, 5.6 [95% confidence interval {CI}, 1.4-23];P= .02) and prior ciprofloxacin exposure (OR, 5.0 [95% CI, 1.2-21];P= .03). Independent risk factors for presence of MDR-PA were a Charlson score greater than 2 (OR, 3.3 [95% CI 1.8-6.0];P<.001) and exposure to quinolones (OR, 2.8 [95% CI, 1.2-5.0];P= .001), third- and fourth-generation cephalosporins (OR, 3.5 [95% CI, 1.7-7.1];P<.001), imipenem (OR, 3.8 [95% CI, 1.2-12.1];P= .02), and/or aminoglycosides (OR, 2.3 [95% CI, 1.04-5.1];P= .04).Conclusion.There were substantial differences in exposure to individual antimicrobials between patients harboring CRPA and patients harboring MDR-PA. Future case-control studies addressing risk factors for single-drug–resistant bacteria should consider the complete susceptibility profile of the bacteria under investigation.

scholarly journals Characteristics of and risk factors for biliary pathogen infection in patients with acute pancreatitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shayan Chen ◽  
Jiyu Shi ◽  
Minghui Chen ◽  
Jun Ma ◽  
Zhaowei Zeng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Pseudomonas Aeruginosa ◽  
Drug Resistance ◽  
Acute Pancreatitis ◽  
Klebsiella Pneumoniae ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Gram Negative

Abstract Background Infection in patients with acute pancreatitis, especially severe acute pancreatitis patients, is a common and important phenomenon, and the distributions and drug resistance profiles of bacteria causing biliary infection and related risk factors are dynamic. We conducted this study to explore the characteristics of and risk factors for bacterial infection in the biliary tract to understand antimicrobial susceptibility, promote the rational use of antibiotics, control multidrug-resistant bacterial infections and provide guidance for the treatment of acute pancreatitis caused by drug-resistant bacteria. Methods The distribution of 132 strains of biliary pathogenic bacteria in patients with acute pancreatitis from January 2016 to December 2020 were analyzed. We assessed drug resistance in the dominant Gram-negative bacteria and studied the drug resistance profiles of multidrug-resistant bacteria by classifying Enterobacteriaceae and nonfermentative bacteria. We then retrospectively analyzed the clinical data and risk factors associated with 72 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (50 cases) and non-multidrug-resistant bacteria (22 cases). Results The main bacteria were Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa. Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli had a 66.67% detection rate. Acinetobacter baumannii had more than 50.00% drug resistance to carbapenems, ESBL-producing Klebsiella pneumoniae had 100.00% drug resistance, and Pseudomonas aeruginosa had 66.67% resistance to carbapenems. Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for Gram-negative multidrug-resistant biliary bacterial infection in acute pancreatitis patients. Conclusion Drug resistance among biliary pathogens in acute pancreatitis patients remains high; therefore, rational antimicrobial drug use and control measures should be carried out considering associated risk factors to improve diagnosis and treatment quality in acute pancreatitis patients.

scholarly journals The Acquisition of Multidrug-Resistant Bacteria in Patients Admitted to COVID-19 Intensive Care Units: A Monocentric Retrospective Case Control Study

2020 ◽  
Vol 8 (11) ◽  
pp. 1821
Author(s):  
Elisa G. Bogossian ◽  
Fabio S. Taccone ◽  
Antonio Izzi ◽  
Nicolas Yin ◽  
Alessandra Garufi ◽  
...  
Keyword(s):  
Intensive Care ◽  
Risk Analysis ◽  
Case Control Study ◽  
Multidrug Resistant ◽  
Case Control ◽  
Incidence Density ◽  
Resistant Bacteria ◽  
Competing Risk Analysis ◽  
Multidrug Resistant Bacteria ◽  
Control Study

Whether the risk of multidrug-resistant bacteria (MDRB) acquisition in the intensive care unit (ICU) is modified by the COVID-19 crisis is unknown. In this single center case control study, we measured the rate of MDRB acquisition in patients admitted in COVID-19 ICU and compared it with patients admitted in the same ICU for subarachnoid hemorrhage (controls) matched 1:1 on length of ICU stay and mechanical ventilation. All patients were systematically and repeatedly screened for MDRB carriage. We compared the rate of MDRB acquisition in COVID-19 patients and in control using a competing risk analysis. Of note, although we tried to match COVID-19 patients with septic shock patients, we were unable due to the longer stay of COVID-19 patients. Among 72 patients admitted to the COVID-19 ICUs, 33% acquired 31 MDRB during ICU stay. The incidence density of MDRB acquisition was 30/1000 patient days. Antimicrobial therapy and exposure time were associated with higher rate of MDRB acquisition. Among the 72 SAH patients, 21% acquired MDRB, with an incidence density was 18/1000 patient days. The septic patients had more comorbidities and a greater number of previous hospitalizations than the COVID-19 patients. The incidence density of MDRB acquisition was 30/1000 patient days. The association between COVID-19 and MDRB acquisition (compared to control) risk did not reach statistical significance in the multivariable competing risk analysis (sHR 1.71 (CI 95% 0.93–3.21)). Thus, we conclude that, despite strong physical isolation, acquisition rate of MDRB in ICU patients was at least similar during the COVID-19 first wave compared to previous period.

SAT-045-Prevalence, type and risk factors of colonization by multidrug-resistant bacteria in a large series of patients with decompensated cirrhosis

2019 ◽  
Vol 70 (1) ◽  
pp. e646-e647
Author(s):  
Maria Hernandez-Tejero ◽  
Fatima Aziz ◽  
Cristina Pitart ◽  
Francesc Marco Reverte ◽  
Irene Campo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multidrug Resistant ◽  
Large Series ◽  
Decompensated Cirrhosis ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria

scholarly journals Isolation of Multidrug Resistant Bacteria from Aspirates of Cancer Patients

2019 ◽  
Vol 35 (1) ◽  
pp. 61-66
Author(s):  
Sunjukta Ahsan ◽  
Rayhan Mahmud ◽  
Kajal Ahsan ◽  
Shamima Begum
Keyword(s):  
Cancer Patients ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Drug Resistant ◽  
Multidrug Resistant Bacteria ◽  
Esbl Producer ◽  
Drug Resistant Bacteria ◽  
Treatment Facilities ◽  
Isolated Species

Infections due to Gram-negative bacteria are common affairs in cancer patients during aggressive therapy. The present study characterizedmulti-drug resistant bacteria (MDR) isolated from cancer aspirates collected from patients admitted to the National Cancer Hospital in Dhaka, Bangladesh. A total of 210 aspirate samples were collected from cancer patients. Out of 210 samples Acinetobacter spp.led the list of isolates (8.89%, n=45). Of these species, 50% exhibited resistance to Amoxycillin and Nitrofurantoin, each, 25% exhibited resistant to Cefotaxime, Azithromycin, Ciprofloxacin, Clindamycin, and Sulfamethoxazole. A total of 33.33% of the Bordetella spp.which accounted 6.67%of the total isolates exhibited resistance to Cefotaxime. All oftheLegionellapneumophila,comprising 4.4%of the isolated species, wereresistant to Cefotaxime, Azithromycin, and Clindamycin.In contrast, 50% were resistant to Cefotaxime, Azithromycin, and Ceftriaxone. Of the Escherichia coli(4.4%, n=45) isolated,50% exhibited resistance to Cefotaxime, Clindamycin, Ceftriaxone, Amoxycillinand Sulfamethoxazole.The only isolate of Klebsiella sp. was demonstrated to be an ESBL producer. The isolation of multidrug resistant bacteria from cancer patients is of particular concern in Bangladesh where cancer and drug resistance are both common phenomena but treatment facilities are poor. To our knowledge this is the first report of the isolation of drug resistant bacteria from cancer patients from Dhaka city. Bangladesh J Microbiol, Volume 35 Number 1 June 2018, pp 61-66

scholarly journals Risk factors for fecal carriage of multidrug-resistant Escherichia coli in a college community: a penalized regression model

2020 ◽  
Author(s):  
Yuan Hu ◽  
Julia Rubin ◽  
Kaitlyn Mussio ◽  
Lee W. Riley
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Logistic Regression ◽  
Penalized Regression ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
E Coli ◽  
College Community ◽  
Fecal Carriage

AbstractBackgroundBacterial antimicrobial resistance is a serious global public health threat. Intestinal commensal drug-resistant bacteria have been suggested as an important reservoir of antimicrobial resistant genes (ARGs), which may be acquired via food. We aimed to identify risk factors associated with fecal carriage of drug-resistant commensal Escherichia coli (E. coli) among healthy adults focused on their dietary habit.MethodsWe conducted a cross-sectional study targeting healthy adult volunteers in a college community. Fecal samples and questionnaires were obtained from 113 volunteers. We conducted backward elimination logistic regression and least absolute shrinkage and selection (LASSO) methods to identify risk factors.ResultsWe analyzed responses from 81 of 113 volunteers who completed the questionnaire. The logistic regression and LASSO methods identified red meat consumption to be associated with increased risk (OR = 6.13 [1.83-24.2] and 1.82, respectively) and fish consumption with reduced risk (OR = 0.27 [0.08-0.85] and 0.82) for the carriage of multidrug-resistant E. coli, adjusted for gender, employment status, frequently-used supermarket, and previous travel.ConclusionsDietary habits are associated with the risk of fecal carriage of multidrug-resistant E. coli. This study supports the growing evidence that food may be an important source of ARGs present in human commensal E. coli.

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