Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections

J Hosp Infect. 2018 Mar;98(3):260-263. doi: 10.1016/j.jhin.2017.11.014. Epub 2017 Dec 15.

Abstract

This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality.

Keywords: Bloodstream; Colistin MIC; Gram-negative; Health care.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / pharmacology*
  • Bacteremia / microbiology
  • Bacteremia / mortality*
  • Carbapenems / pharmacology
  • Colistin / pharmacology*
  • Cross Infection / microbiology
  • Cross Infection / mortality*
  • Female
  • Gram-Negative Bacteria / drug effects*
  • Gram-Negative Bacteria / isolation & purification
  • Gram-Negative Bacterial Infections / microbiology
  • Gram-Negative Bacterial Infections / mortality*
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Retrospective Studies

Substances

  • Anti-Bacterial Agents
  • Carbapenems
  • Colistin