MULTIDRUG RESISTANT GRAM NEGATIVE ORGANISMS: EPIDEMIOLOGY AND OUTCOMES IN THE ICU

Abstract

With the increasing global threat of antimicrobial resistance especially among Gram-negative bacteria (GNB), a prospective observational study(Aug?07-Dec?11) including 2949 patients who had stayed for more than 24-hours in the intensive care unit (ICU) was conducted at the National University Hospital. A prediction tool for nosocomial ICU acquired multidrug-resistant (MDR)-GNB infection was constructed using independent risk factors identified and was validated. The effects of initial inappropriate antibiotics on mortality along with resistance selection from empiric broad spectrum therapy were also quantified. Economic impact was evaluated using a propensity score approach. We believe that our validated prediction tool will help target empirical antibiotics for high risk ICU patients; for the remainder, a 72-hour window period was identified for antibiotic adjustment to improve survival while minimizing collateral damage among patients with GNB infection. This will help safely reduce the problem of antimicrobial resistance amongst critically ill patients.