Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France.
Anaesthesiology and Critical Care Department, Amiens University Medical Center, Amiens, France; INSERM U 1088, University of Picardie Jules Verne, Centre Universitaire de Recherche en Santé, Amiens, France.
J Hosp Infect. 2019 Jul;102(3):317-324. doi: 10.1016/j.jhin.2019.01.011. Epub 2019 Jan 17.
Bacterial resistance to antibiotics is a daily concern in intensive care units. However, few data are available concerning the clinical consequences of in-vitro-defined resistance.
To compare the mortality of patients with nosocomial infections according to bacterial resistance profiles.
The prospective surveillance registry in 29 French intensive care units (ICUs) participating during the years 2000-2013 was retrospectively analysed. All patients presenting with a nosocomial infection in ICU were included.
The registry contained 88,000 eligible patients, including 10,001 patients with a nosocomial infection. Among them, 3092 (36.7%) were related to resistant micro-organisms. Gram-negative bacilli exhibited the highest rate of resistance compared to Gram-positive cocci (52.8% vs 48.1%; P < 0.001). In-hospital mortality was higher in cases of patients with antibiotic-resistant infectious agents (51.9% vs 45.5%; P < 0.001), and critical care length of stay was longer (33 ± 26 vs 29 ± 22 days; P < 0.001). These results remained significant after SAPS II matching (P < 0.001) and in the Gram-negative bacilli and Gram-positive cocci subgroups. No difference in mortality was found with respect to origin prior to admission.
Patients with bacterial resistance had higher ICU mortality and increased length of stay, regardless of the bacterial species or origin of the patient.
细菌对抗生素的耐药性是重症监护病房（ICU）每天都要面对的问题。然而，目前关于体外定义的耐药性对临床后果的相关数据却很少。
比较根据细菌耐药谱确定的医院感染患者的死亡率。
对 29 家法国 ICU 参与的 2000 年至 2013 年的前瞻性监测登记进行回顾性分析。所有在 ICU 中发生医院感染的患者均被纳入。
该登记册包含 88000 名合格患者，其中 10001 名患者发生医院感染。其中，3092 名（36.7%）与耐药微生物有关。与革兰氏阳性球菌相比，革兰氏阴性杆菌的耐药率更高（52.8%比 48.1%；P < 0.001）。患有抗生素耐药感染性疾病的患者的院内死亡率更高（51.9%比 45.5%；P < 0.001），且 ICU 住院时间更长（33 ± 26 比 29 ± 22 天；P < 0.001）。在 SAPS II 匹配后（P < 0.001）和革兰氏阴性杆菌和革兰氏阳性球菌亚组中，这些结果仍然具有显著性。入院前来源的不同与死亡率无差异。
无论细菌种类或患者来源如何，具有细菌耐药性的患者 ICU 死亡率更高，住院时间更长。
