Review of studies of the impact on Gram-negative bacterial resistance on outcomes in the intensive care unit.

Abstract

OBJECTIVE:

To review studies addressing mortality, length of stay (LOS), and cost of resistant Gram-negative bacterial infections in the intensive care unit (ICU).

DATA SOURCES AND STUDY SELECTION:

A qualitative review of published studies identified through PubMed search was performed. Study exclusion criteria were population <40 adults or <39% of cases in the ICU. Criteria for judging study quality were prospective analysis, multicenter study, author-specified diagnostic criteria, appropriate control group defined as patients with infections caused by susceptible bacteria, adjustments for confounding factors, and use of cost.

DATA EXTRACTION AND SYNTHESIS:

Twenty-one original studies and a meta-analysis, which included three of the original studies, were identified. Infections caused by mixed resistant Gram-negative bacteria, extended-spectrum beta-lactamase-producing Enterobacteriaceae, multidrug-resistant Pseudomonas aeruginosa, and Acinetobacter species were generally associated with increased mortality and LOS, especially in univariate analyses. Economic analyses performed in eight studies indicated that these resistant Gram-negative infections were also associated with increased patient charges or hospital costs. Associations sometimes disappeared in multivariate analyses after adjusting for variables significant in univariate analyses.

CONCLUSION:

The collective findings of the studies in this review suggested that Gram-negative bacterial resistance increases the burden in the ICU as measured by mortality, LOS, and charges. More prospective studies are needed to explore methods for combating Gram-negative resistance, including prevention, education, and better antimicrobial therapy. For example, well-designed research is needed to determine the cost-effectiveness of appropriate empiric therapy with broad-spectrum agents active against resistant Gram-negative bacteria followed by de-escalation.

• Authors: Andrew F Shorr
• Journal: Critical care medicine (Crit Care Med) Vol. 37 Issue 4 Pg. 1463-9 (Apr 2009) ISSN: 1530-0293 [Electronic] United States
• PMID: 19242341 (Publication Type: Journal Article, Review)

Topics

• Costs and Cost Analysis
• Drug Resistance, Bacterial
• Gram-Positive Bacterial Infections (drug therapy, economics, mortality)
• Humans
• Intensive Care Units
• Length of Stay (statistics & numerical data)
• Treatment Outcome