Attributable mortality of antibiotic resistance in gram-negative infections in the Netherlands: a parallel matched cohort study. (May 2021)

• Record Type: Journal Article
• Authors: Rottier, Wouter C.; Deelen, J.W. Timotëus; Caruana, Giorgia; Buiting, Anton G.M.; Dorigo-Zetsma, J. Wendelien; Kluytmans, Jan A.J.W.; van der Linden, Paul D.; Thijsen, Steven F.T.; Vlaminckx, Bart J.M.; Weersink, Annemarie J.L.; Ammerlaan, Heidi S.M.; Bonten, Marc J.M.
• Is Part Of: Clinical microbiology and infection. Volume 27:Number 5(2021)
• Page Start: 742
• Page End: 749
• Publication Date: 2021-05
• Subjects: Bacteraemia -- Burden of antimicrobial resistance -- Enterobacterales -- Extended-spectrum beta-lactamase -- Nonbacteraemic infection; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2020.07.014
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Objectives: Antibiotic resistance in Gram-negative bacteria has been associated with increased mortality. This was demonstrated mostly for third-generation cephalosporin-resistant (3GC-R) Enterobacterales bacteraemia in international studies. Yet, the burden of resistance specifically in the Netherlands and created by all types of Gram-negative infection has not been quantified. We therefore investigated the attributable mortality of antibiotic resistance in Gram-negative infections in the Netherlands. Methods: In eight hospitals, a sample of Gram-negative infections was identified between 2013 and 2016, and separated into resistant and susceptible infection cohorts. Both cohorts were matched 1:1 to non-infected control patients on hospital, length of stay at infection onset, and age. In this parallel matched cohort set-up, 30-day mortality was compared between infected and non-infected patients. The impact of resistance was then assessed by dividing the two separate risk ratios (RRs) for mortality attributable to Gram-negative infection. Results: We identified 1954 Gram-negative infections, of which 1190 (61%) involved Escherichia coli, 210 (11%) Pseudomonas aeruginosa, and 758 (39%) bacteraemia. Resistant Gram-negatives caused 243 infections (12%; 189 (78%) 3GC-R Enterobacterales, nine (4%) multidrug-resistant P. aeruginosa, no carbapenemase-producing Enterobacterales). Subsequently, we matched 1941 non-infected controls. After adjustment, point estimates for RRs comparing mortality between infections and controls were similarly higher than 1 in case of resistant infections and susceptible infections (1.42 (95% confidence interval 0.66–3.09) and 1.32 (1.06–1.65), respectively). By dividing these, the RR reflecting attributable mortality of resistance was calculated as 1.08 (0.48–2.41). Conclusions: In the Netherlands, antibiotic resistance did not increase 30-day mortality in Gram-negative infections.