Risk factors and clinical impact of multidrug resistance in healthcare-associated bacteraemic urinary tract infections : a post-hoc analysis of a multicentre prospective cohort in Spain
Gómez-Zorrilla, S. (Institut Hospital del Mar d'Investigacions Mèdiques)
Becerra-Aparicio, F. (Hospital Universitario Ramón y Cajal (Madrid))
Sendra, Elena (Institut Hospital del Mar d'Investigacions Mèdiques)
Zamorano, L. (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Grau, I. (Hospital Universitari de Bellvitge)
Pintado, V. (Hospital Universitario Ramón y Cajal (Madrid))
Padilla, B. (Hospital General Universitario Gregorio Marañón)
Benito, Natividad (Institut de Recerca Sant Pau)
Boix-Palop, L. (Hospital Mútua de Terrassa)
Fariñas, M.C. (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
Peñaranda, M. (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Gamallo, M.R. (Complejo Hospitalario Universitario de Pontevedra)
Martinez, J.A. (Hospital Clínic i Provincial de Barcelona)
Morte-Romea, E. (Hospital Clínico Universitario "Lozano Blesa" de Zaragoza)
Del Pozo, J.L. (Clínica Universidad de Navarra)
López Montesinos, I. (Institut Hospital del Mar d'Investigacions Mèdiques)
Duran-Jordà, Xavier (Institut Hospital del Mar d'Investigacions Mèdiques)
Ponz, R. (MSD Spain)
Cotarelo, M. (MSD Spain)
Cantón, R. (Hospital Universitario Ramón y Cajal (Madrid))
Oliver, Antonio (Instituto de Investigación Sanitaria Illes Balears (IdISBa))
Ruiz-Garbajosa, P. (Hospital Universitario Ramón y Cajal (Madrid))
Horcajada, J. P. (Institut Hospital del Mar d'Investigacions Mèdiques)
Universitat Autònoma de Barcelona

Date:	2024
Abstract:	The global burden associated with antimicrobial resistance is of increasing concern. Aim: To evaluate risk factors associated with multidrug-resistant (MDR) infection and its clinical impact in a cohort of patients with healthcare-associated bacteraemic urinary tract infections (BUTIs). Methods: This was a prospective, multicentre, post-hoc analysis of patients with healthcare-associated-BUTI (ITUBRAS-2). The primary outcome was MDR profile. Secondary outcomes were clinical response (at 48-72 h and at hospital discharge) and length of hospital stay from onset of BUTI. Logistic regression was used to evaluate variables associated with MDR profile and clinical response. Length of hospital stay was evaluated using multivariate median regression. Findings: In all, 443 episodes were included, of which 271 (61. 17%) were classified as expressing an MDR profile. In univariate analysis, MDR profile was associated with E. coli episodes (odds ratio (OR): 3. 13; 95% confidence interval (CI): 2. 11-4. 69, P < 0. 001) and the extensively drug-resistant (XDR) pattern with P. aeruginosa aetiology (7. 84; 2. 37-25. 95; P = 0. 001). MDR was independently associated with prior use of fluoroquinolones (adjusted OR: 2. 43; 95% CI: 1. 25-4. 69), cephalosporins (2. 14; 1. 35-3. 41), and imipenem or meropenem (2. 08; 1. 03-4. 20) but not with prior ertapenem. In terms of outcomes, MDR profile was not associated with lower frequency of clinical cure, but was associated with longer hospital stay. Conclusion: MDR profile was independently associated with prior use of fluoroquinolones, cephalosporins, imipenem, and meropenem, but not with prior ertapenem. MDR-BUTI episodes were not associated with worse clinical cure, although they were independently associated with longer duration of hospital stay.
Grants:	Ministerio de Economía y Competitividad RD16/0016/0004 Ministerio de Economía y Competitividad RD16/0016/0005 Ministerio de Economía y Competitividad RD16/0016/0007 Ministerio de Economía y Competitividad RD16/0016/0010 Ministerio de Economía y Competitividad RD16/0016/0011 Ministerio de Economía y Competitividad RD16/0016/0015
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Bloodstream infections ; Extended-spectrum β-lactamase ; Healthcare-associated infections ; Hospital-acquired infections ; Multidrug resistance ; Urinary tract infections
Published in:	The journal of hospital infection, Vol. 151 (september 2024) , p. 173-185, ISSN 1532-2939

DOI: 10.1016/j.jhin.2024.05.020
PMID: 38945399

13 p, 354.2 KB

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