Risk factors for polymyxin-resistant carbapenemase-producing Enterobacteriaceae in critically patients: An epidemiological and clinical study.
da Silva KE., Baker S., Croda J., Nguyen TNT., Boinett CJ., Barbosa LS., Tetila A., Simionatto S.
We aimed to assess the clinical impact and potential risk factors associated with polymyxin-resistance Enterobacteriaceae strains isolated from patients hospitalized in adult and neonatal Intensive Care Units. We conducted a case-control study from September/2015 to January/2017. Antimicrobial susceptibility of polymyxin-resistance Enterobacteriaceae strains was determined by broth microdilution. The presence of resistance genes was evaluated by PCR and DNA sequencing. Renal failure (p=0.02; OR 11.37; 95% CI 1.0-128.63), urinary catheter (p<0.01; OR 4.16; 95% CI 38.82-366.07), transference between hospital units (p=0.03; OR 9.98; 95% CI 1.01-98.42), carbapenem use (p<0.01; OR 45.49; 95% CI 6.93-298.62) and surgical procedure (p<0.01; OR 16.52; 95% CI 2.83-96.32) were risk factors for the acquisition of polymyxin-resistant strains in adult patients. For the neonatal patients, central venous catheter (p<0.01; OR 69.59; 95% CI 7.33-660.30) was the only risk factors associated with polymyxin-resistant. Analysis of the outcomes revealed that mortality rate was significantly higher in adults (66.6%) and newborns (23.5%) patients with polymyxin-resistant than those polymyxin-susceptible strains. In addition,carbapenem exposure (p<0.01; OR 50.93; 95% CI 2.26->999.999) were strongly associated with mortality. On the other hand, aminoglycosides use (p<0.03; OR 0.06; 95% CI 0.004-0.97) was a protection factor for mortality by polymyxin-resistant strains. Several risk factors were associated with polymyxin-resistance strains. The high mortality rates showed that acquisition of these strains is a predictor for unfavorable outcomes. Additionally, the therapy of aminoglycosides/polymyxin might be a better combination to improve patient outcomes.