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Outcomes of carbapenem-resistant Enterobacteriaceae isolation: matched analysis.
Bogan, Christopher; Kaye, Keith S; Chopra, Teena; Hayakawa, Kayoko; Pogue, Jason M; Lephart, Paul R; Bheemreddy, Suchitha; Lazarovitch, Tsilia; Zaidenstein, Ronit; Perez, Federico; Bonomo, Robert A; Marchaim, Dror.
Afiliación
  • Bogan C; Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
  • Kaye KS; Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
  • Chopra T; Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
  • Hayakawa K; Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
  • Pogue JM; Department of Pharmacy Services, Detroit Medical Center, Wayne State University, Detroit, MI.
  • Lephart PR; Department of Clinical Microbiology, Detroit Medical Center, Wayne State University, Detroit, MI.
  • Bheemreddy S; Department of Medicine, Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI.
  • Lazarovitch T; Department of Clinical Microbiology, Assaf Harofeh Medical Center, Zerifin, Israel.
  • Zaidenstein R; Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel.
  • Perez F; VISN 10 Geriatric Research, Education, and Clinical Centers (GRECC) at Veterans Affairs Medical Center, Cleveland, OH; Department of Medicine, Veterans Affairs Medical Center, Cleveland, OH.
  • Bonomo RA; VISN 10 Geriatric Research, Education, and Clinical Centers (GRECC) at Veterans Affairs Medical Center, Cleveland, OH; Department of Medicine, Veterans Affairs Medical Center, Cleveland, OH; Research Service, Veterans Affairs Medical Center, Cleveland, OH; Department of Pharmacology, Case Western Re
  • Marchaim D; Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. Electronic address: drormc@hotmail.com.
Am J Infect Control ; 42(6): 612-20, 2014 Jun.
Article en En | MEDLINE | ID: mdl-24837111
BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) isolation is associated with poor outcomes. The matched cohort study design enables investigation of specific role of resistance in contributing to patients' outcomes. Patients with CRE were matched to 3 groups: (1) patients with extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL), (2) patients with carbapenem-susceptible non-ESBL Enterobacteriaceae, and (3) uninfected controls. METHODS: Patients with CRE isolated at Detroit Medical Center (September 1, 2008, to August 31, 2009) were matched (1:1 ratio) to the 3 groups based on (1) bacteria type, (2) hospital/facility, (3) unit/clinic, (4) calendar year, and (5) time at risk (ie, from admission to culture). Multivariable logistic regression models for outcomes were constructed. RESULTS: Ninety-one patients with CRE were enrolled. CRE isolation was not an independent predictor for in-hospital mortality in any of the models (ie, vs uncolonized controls, vs ESBL, vs non-ESBL Enterobacteriaceae, and vs all 3 non-CRE groups combined), despite high significance of association in bivariate analyses. CRE isolation was independently associated with deterioration in functional status [odds ratio, 9; P = .002] and being discharged to a long-term care facility after being admitted to the hospital from home [odds ratio, 13.7; P < .001]. CONCLUSION: Underlying condition and comorbidities are the principal factors responsible for in-hospital mortality in CRE infections; however, in-hospital mortality is not independently correlated to the offending pathogen. In addition, we found that the pathogen contributes significantly to patients' degree of morbidity.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mortalidad Hospitalaria / Resistencia betalactámica / Enterobacteriaceae / Infecciones por Enterobacteriaceae Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Infect Control Año: 2014 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Mortalidad Hospitalaria / Resistencia betalactámica / Enterobacteriaceae / Infecciones por Enterobacteriaceae Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Infect Control Año: 2014 Tipo del documento: Article Pais de publicación: Estados Unidos