In:
Critical Care Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 10 ( 2016-10), p. e949-e956
Abstract:
To determine the time-dependent effect of antibiotics on the initial acquisition of carbapenem-resistant Acinetobacter baumannii . Design: Retrospective cohort study. Setting: Forty-bed trauma ICU in Miami, FL. Patients: All consecutive patients admitted to the unit from November 1, 2010, to November 30, 2011. Interventions: None. Measurements and Main Results: Patients underwent surveillance cultures at admission to the unit and weekly thereafter. The primary outcome was the acquisition of carbapenem-resistant A. baumannii on surveillance cultures. Daily antibiotic exposures during the time of observation were used to construct time-dependent variables, including cumulative exposures (in grams and daily observed doses [defined daily doses]). Among 360 patients, 45 (12.5%) became colonized with carbapenem-resistant A. baumannii . Adjusted Cox models showed that each additional point in the Acute Physiologic and Chronic Health Evaluation score increased the hazard by 4.8% (hazard ratio, 1.048; 95% CI, 1.010–1.087; p = 0.0124) and time-dependent exposure to carbapenems quadrupled the hazard (hazard ratio, 4.087; 95% CI, 1.873–8.920; p = 0.0004) of acquiring carbapenem-resistant A. baumannii . Additionally, adjusted Cox models determined that every additional carbapenem defined daily dose increased the hazard of acquiring carbapenem-resistant A. baumannii by 5.1% (hazard ratio, 1.051; 95% CI, 1.007–1.093; p = 0.0243). Conclusions: Carbapenem exposure quadrupled the hazards of acquiring A. baumannii even after controlling for severity of illness.
Type of Medium:
Online Resource
ISSN:
0090-3493
DOI:
10.1097/CCM.0000000000001848
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2016
detail.hit.zdb_id:
2034247-0
