dc.creator | Koukoubani T., Makris D., Daniil Z., Paraforou T., Tsolaki V., Zakynthinos E., Papanikolaou J. | en |
dc.date.accessioned | 2023-01-31T08:45:13Z | |
dc.date.available | 2023-01-31T08:45:13Z | |
dc.date.issued | 2021 | |
dc.identifier | 10.1186/s12955-021-01712-0 | |
dc.identifier.issn | 14777525 | |
dc.identifier.uri | http://hdl.handle.net/11615/75274 | |
dc.description.abstract | Background: In the recent era, antimicrobial resistance has been identified as one of the most important threats to human health worldwide. The rapid emergence of antibiotic-resistant pathogens (ABRP) in the modern intensive care unit (ICU) also represents a “nightmare scenario” with unknown clinical consequences. In the Greek ICU, in particular, gram negative ABRPs are now considered endemic. However, the possible longitudinal impact of ABRPs on long-term outcomes of ICU patients has not yet been determined. Methods: In this two-year (January 2014-December 2015) single-centre observational longitudinal study, 351 non-neurocritical ICU patients ≥ 18 year-old were enrolled. Patients’ demographic, clinical and outcome data were prospectively collected. Quality-adjusted life years (QALY) were calculated at 6, 12, 18 and 24 months after ICU admission. Results: Fifty-eight patients developed infections due to ABRP (ABRP group), 57 due to non-ABRP (non-ABRP group), and 236 demonstrated no infection (no-infection group) while in ICU. Multiple regression analysis revealed that multiple organ dysfunction syndrome score (OR: 0.676, 95%CI 0.584–0.782; P < 0.001) and continuous renal replacement therapy (OR: 4.453, 95%CI 1.805–10.982; P = 0.001) were the only independent determinants for ABRP infections in ICU. Intra-ICU, 90-day and 2-year mortality was 27.9%, 52.4% and 61.5%, respectively. Compared to the non-ABRP and no-infection group, the ABRP group demonstrated increased intra-ICU, 90-day and 2-year mortality (P ≤ 0.022), worse 2-year survival rates in ICU patients overall and ICU survivor subset (Log-rank test, P ≤ 0.046), and poorer progress over time in 2-year QALY kinetics in ICU population overall, ICU survivor and 2-year survivor subgroups (P ≤ 0.013). ABRP group was further divided into multi-drug and extensively-drug resistant subgroups [MDR (n = 34) / XDR (n = 24), respectively]. Compared to MDR subgroup, the XDR subgroup demonstrated increased ICU, 90-day and 2-year mortality (P ≤ 0.031), but similar 90-day and 2-year QALYs (P ≥ 0.549). ABRP infections overall (HR = 1.778, 95% CI 1.166–2.711; P = 0.008), as well as XDR [HR = 1.889, 95% CI 1.075–3.320; P = 0.027) but not MDR pathogens, were independently associated with 2-year mortality, after adjusting for several covariates of critical illness. Conclusions: The present study may suggest a significant association between ABRP (especially XDR) infections in ICU and increased mortality and inability rates for a prolonged period post-discharge that requires further attention in larger-scale studies. © 2021, The Author(s). | en |
dc.language.iso | en | en |
dc.source | Health and Quality of Life Outcomes | en |
dc.source.uri | https://www.scopus.com/inward/record.uri?eid=2-s2.0-85102006712&doi=10.1186%2fs12955-021-01712-0&partnerID=40&md5=e6b91f4329e146d3d674522b0f345b94 | |
dc.subject | antibiotic agent | en |
dc.subject | antiinfective agent | en |
dc.subject | adult | en |
dc.subject | aged | en |
dc.subject | antibiotic resistance | en |
dc.subject | Article | en |
dc.subject | bacterial infection | en |
dc.subject | continuous renal replacement therapy | en |
dc.subject | controlled study | en |
dc.subject | critically ill patient | en |
dc.subject | demography | en |
dc.subject | extensive drug resistance | en |
dc.subject | female | en |
dc.subject | Greece | en |
dc.subject | hospital admission | en |
dc.subject | hospital discharge | en |
dc.subject | human | en |
dc.subject | long term mortality | en |
dc.subject | long term outcome | en |
dc.subject | longitudinal study | en |
dc.subject | major clinical study | en |
dc.subject | male | en |
dc.subject | mortality | en |
dc.subject | multidrug resistant bacterium | en |
dc.subject | multiple organ failure | en |
dc.subject | neurological intensive care unit | en |
dc.subject | prospective study | en |
dc.subject | quality adjusted life year | en |
dc.subject | quality of life | en |
dc.subject | survivor | en |
dc.subject | treatment outcome | en |
dc.subject | bacterial infection | en |
dc.subject | case control study | en |
dc.subject | critical illness | en |
dc.subject | intensive care unit | en |
dc.subject | middle aged | en |
dc.subject | organ dysfunction score | en |
dc.subject | risk factor | en |
dc.subject | Anti-Bacterial Agents | en |
dc.subject | Bacterial Infections | en |
dc.subject | Case-Control Studies | en |
dc.subject | Critical Illness | en |
dc.subject | Drug Resistance, Bacterial | en |
dc.subject | Female | en |
dc.subject | Humans | en |
dc.subject | Intensive Care Units | en |
dc.subject | Longitudinal Studies | en |
dc.subject | Male | en |
dc.subject | Middle Aged | en |
dc.subject | Organ Dysfunction Scores | en |
dc.subject | Prospective Studies | en |
dc.subject | Quality of Life | en |
dc.subject | Quality-Adjusted Life Years | en |
dc.subject | Risk Factors | en |
dc.subject | BioMed Central Ltd | en |
dc.title | The role of antimicrobial resistance on long-term mortality and quality of life in critically ill patients: a prospective longitudinal 2-year study | en |
dc.type | journalArticle | en |