Community-onset/-acquired multidrug-resistant infections: increased rates portend poor outcomes for elderly

  • I LM & al.
  • J Infect
  • 06/01/2020

  • Liz Scherer
  • Clinical Essentials
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Takeaway

  • Increasing rates of community-acquired (CA) multidrug-resistant (MDR) infections are linked to hospitalizations, longer length of stay (LOS), and clinical failure in elderly patients with comorbidities.

Why this matters

  • This increase in CA-MDR infections warrants clinical vigilance and timely diagnosis.
  • Familiarity with locally circulating MDR pathogens and effective treatment is recommended.

Key results

  • Among 194 patients, 60.8% (59/97) MDR isolates were community-onset (CO) health-care-associated (HCA) infections.
  • Most common CO-HCA infection risk factors:
    • Hospitalization
    • Chemotherapy, home intravenous therapy, or wound care: 7.2% (n=7).
  • Vs non-MDR patients, MDR patients had higher rates of:
    • Day 30 clinical failure : 16.5% vs 7.2% (P=.046),
    • All-cause mortality: 35.1% vs 21.6% (P=.038).
  • Multivariate, day-30 clinical failure was significantly associated (ORs) with:
    • Age: 1.07 (P=.038),
    • Sequential organ failure assessment score: 1.45 (P=.002).
  • All-cause mortality with MDR was tied to (HRs):
    • Age: 1.06 (P<.001>
    • Higher Charlson score: 1.2 (P=.002). 
  • Vs non-MDR, MDR was linked to longer:
    • Hospital LOS: median, 11 (interquartile range [IQR], 7-16) days vs 7 (IQR, 5-11) days (P<.001 and>
    • Stays in emergency department: median, 1 (IQR, 1-2) day vs 1 (IQR, 1-1.75) day (P<.001>

Study design

  • Case-control analysis of clinical impact of CA-, CO-HCA MDR infections of any kind requiring hospitalization in Spanish adults, 2015-2016.
  • Funding: None.

Limitations

  • Retrospective.
  • Limited generalizability.
  • Heterogeneity bias.
  • Missing confounders.