Limited Impact of Colistin Resistance on Mortality of Intensive Care Patients with Carbapenem-resistant Bacteraemia
Our latest research article just appeared in the Journal of Hospital Infection, 15, August 2024.
Limited Impact of Colistin Resistance on Mortality of Intensive Care Patients with Carbapenem-resistant Bacteraemia
by
Renatos-Nikolaos Tziolos, Stamatis Karakonstantis, Evangelos I. Kritsotakis, Loukia Vassilopoulou, Maria Loukaki, Alberto Tovil, Sophia Kokkini, Kyriaki Tryfinopoulou, Petros Ioannou, Eumorfia Kondili, Diamantis Kofteridis
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Abstract
Background: Increasing incidence of carbapenem-resistant Gram-negative bacteraemia (CR-GNB) has triggered increased use of polymyxins, likely fuelling the emergence and spread of colistin resistance.
Aim: To estimate the excess clinical burden of colistin resistance in intensive care patients with CR-GNB.
Methods: A cohort was constructed of patients with CR-GNB during their stay in the intensive care unit (ICU) of a university hospital in Greece, over a 4-year period (2020-2023). Competing risks survival analysis was performed to estimate the burden associated with colistin resistance.
Findings: In 177 ICU patients with CR-GNB, 134 (76%) had colistin-resistant isolates, predominantly Acinetobacter baumannii (79%), identified by broth microdilution. Patients with colistin resistant infection were similar to those with colistin susceptible with respect to age, sex, APACHE II score, Charlson comorbidity index, Pitt bacteraemia score, prior surgery and the occurrence of polymicrobial cultures. However, patients in the colistin resistant group had lower mortality risk compared to the colistin susceptible (31% vs. 44%, P = 0.004 at 14 days; 46% vs. 56% at 28 days, P = 0.173; respectively). Multivariable regression analysis confirmed that colistin resistant CR-GNB was associated with significantly lower hazard of inpatient death compared to colistin susceptible infection at 14 days (cause-specific hazard ratio [csHR], 0.53; 95% CI 0.28 - 1.01) and 28 days (csHR, 0.55; 95% CI 0.31 - 0.95) of infection onset.
Conclusion: Limited impact of colistin resistance on mortality was demonstrated in a large contemporary cohort of ICU patients with CR-GNB, possibly reflecting the recent shift away from colistin-based treatment regimens.
https://doi.org/10.1016/j.jhin.2024.07.016
Figure
1. Cumulative incidence functions of 28-day inpatient death and hospital discharge alive for N
= 177 patients with carbapenem-resistant gram-negative bacteremia in relation
to colistin resistance status