Risk factors for development of aminoglycoside resistance among gram-negative rods. (30th October 2019)

• Record Type: Journal Article
• Authors: Richter, Stefan E; Miller, Loren; Needleman, Jack; Uslan, Daniel Z; Bell, Douglas; Watson, Karol; Humphries, Romney; McKinnell, James A
• Is Part Of: American journal of health-system pharmacy. Volume 76:Number 22(2019)
• Page Start: 1838
• Page End: 1847
• Publication Date: 2019-10-30
• Subjects: antimicrobial resistance -- clinical decision making -- antimicrobial stewardship -- aminoglycosides -- gram-negative rods; Hospital pharmacies -- United States -- Periodicals; 615.1
• DOI: 10.1093/ajhp/zxz201
• Languages: English
• ISSNs: 1079-2082

Abstract

Abstract: Purpose: Development of scoring systems to predict the risk of aminoglycoside resistance and to guide therapy is described. Methods: Infections due to aminoglycoside-resistant gram-negative rods (AR-GNRs) are increasingly common and associated with adverse outcomes; selection of effective initial antibiotic therapy is necessary to reduce adverse consequences and shorten length of stay. To determine risk factors for AR-GNR recovery from culture, cases of GNR infection among patients admitted to 2 institutions in a major academic hospital system during the period 2011–2016 were retrospectively analyzed. Gentamicin and tobramycin resistance (GTR-GNR) and amikacin resistance (AmR-GNR) patterns were analyzed separately. A total of 26, 154 GNR isolates from 12, 516 patients were analyzed, 6, 699 of which were GTR, and 2, 467 of which were AmR. Results: In multivariate analysis, risk factors for GTR-GNR were presence of weight loss, admission from another medical or long-term care facility, a hemoglobin level of <11 g/dL, receipt of any carbapenem in the prior 30 days, and receipt of any fluoroquinolone in the prior 30 days (C statistic, 0.63). Risk factors for AmR-GNR were diagnosis of cystic fibrosis, male gender, admission from another medical or long-term care facility, ventilation at any point prior to culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-MRSA agent in the prior 30 days (C statistic, 0.74). Multinomial and ordinal models demonstrated that the risk factors for the 2 resistance patterns differed significantly. Conclusion: A scoring system derived from the developed risk prediction models can be applied by providers to guide empirical antimicrobial therapy for treatment of GNR infections.