Factors associated with in-hospital mortality among critically ill surgical patients with multidrug-resistant Gram-negative infections

Andrew S. Jarrell, Rachel M. Kruer, Loredana Diana Berescu, Peter J. Pronovost, Julie B. Trivedi

Research output: Contribution to journalArticle

8 Scopus citations

Abstract

Purpose Multidrug-resistant (MDR) Gram-negative infection increases risk of mortality, other complications, and costs. The objective of this study was to determine the prevalence of and identify factors associated with in-hospital mortality among critically ill surgical patients. Materials and methods This case-control study included critically ill surgical patients from 2011 to 2014 who had a carbapenem-resistant Enterobacteriaceae (CRE), MDR P. aeruginosa, or MDR Acinetobacter spp. infection. Characteristics of patients surviving to hospital discharge were compared to those of non-survivors. Results Sixty-two patients were included. Of these, 21 (33.9%) died prior to discharge. Vasopressors and mechanical ventilation prior to index culture were more common in non-survivors vs. survivors (76.2% vs. 46.3%, p = 0.03; and 100% vs. 63.4%, p = 0.001). ICU and hospital LOS prior to index culture was longer in non-survivors vs. survivors (median 19 vs. 4 days, p = 0.001; and median 25 vs. 7 days, p = 0.009). In multivariate logistic regression, achievement of source control was the only variable associated with decreased in-hospital mortality [0.04 (95% CI 0.003–0.52); p = 0.01]. Conclusions MDR Gram-negative infection is associated with significant in-hospital mortality among critically ill surgical patients. Source control, along with prior ICU LOS, mechanical ventilation status, vasopressor use, and definitive antibiotic choice, are important predictors of survival in this population.

Original languageEnglish (US)
Pages (from-to)321-326
Number of pages6
JournalJournal of Critical Care
Volume43
DOIs
StatePublished - Feb 1 2018

Keywords

  • Acinetobacter
  • CRE
  • Critical illness
  • Mortality
  • Multidrug-resistant Gram-negative
  • Pseudomonas

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Factors associated with in-hospital mortality among critically ill surgical patients with multidrug-resistant Gram-negative infections'. Together they form a unique fingerprint.

  • Cite this