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http://dx.doi.org/10.7586/jkbns.2020.22.4.249

Survival Factors among Medical Intensive Care Unit Patients with Carbapenemas-Producing Enterobacteriaceae  

Choi, Ji Eun (Gyeongsang National University Hospital)
Jeon, Mi Yang (College of Nursing.Institute of Health Science, Gyeongsang National University)
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Journal of Korean Biological Nursing Science / v.22, no.4, 2020 , pp. 249-259 More about this Journal
Abstract
Purpose: Carbapenemase-producing Enterobacteriaceae (CPE) are associated with considerable mortality. This study was aimed to identify survival factors among medical care unit patients with CPE. Methods: We conducted a retrospective cohort; data were collected from September 2017 to June 2019 through electronic medical records. The data collected were general characteristics, disease-related characteristics, severity-related characteristics, and treatment-related characteristics. Data were analyzed based on frequency, mean, standard deviation, Chi-square test, Fisher's exact test, t-test, Pearson's correlation coefficient, and Cox proportional hazard model using SPSS/WIN 21.0 program. Results: Seventy-seven patients were included (59 survivors and 18 deceased) in the study. Univariate analysis identified factors for survival associated with acquired CPE as age (t= -1.56, p= .037), simplified acute physiology 3 (SAPS3) score of admission date (t= -2.85, p= .006), Glasgow coma scale (GCS) of CPE acquisition date (t= 2.38, p= .020), artery catheter at CPE acquisition date (χ2= 4.58, p= .032), vasoconstrictor agents use at CPE acquisition date (χ2= 6.81, p= .009), platelet at CPE acquisition date (t= 2.27, p= .025), lymphocyte at CPE acquisition date (t= 2.01, p= .048), calcium at CPE acquisition date (t= 2.68, p= .009), albumin at CPE acquisition date (t= 2.29, p= .025), and creatinine at CPE acquisition date (t= 2.24, p= .028). Multivariate Cox proportional hazard model showed that GCS at CPE acquisition date (HR= 1.14, 95% CI= 1.05-1.22), lymphocyte at CPE acquisition date (HR= 1.05, 95% CI= 1.00-1.10), and creatinine at CPE acquisition date (HR= 1.25, 95% CI= 1.04-1.49) were independent survival factors among medical intensive care unit patients with CPE. Conclusion: Based on the study results, it is necessary to develop nursing interventions that can aid in the management of patients with CPE and identify their effects.
Keywords
Carbapenemase; Enterobacteriaceae; Intensive care units; Survival;
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1 Organization for Economic Cooperation and Development. OECD Health statistics 2018[Internet]. Paris: OECD; 2018[cited 2020 Jun 5]. Available from: https://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_PHMC
2 Lee SY, Kim HS, Yoo J, Yoo JI, Jung YH. Sentinel surveillance and molecular epidemiology of multidrug resistance bacteria. Korean Journal of Clinical Microbiology. 2012;15(2):43-8. https://doi.org/10.5145/KJCM.2012.15.2.43   DOI
3 Centers for Disease Control and Prevention. Antibiotic resistance threats in the united states 2013[Internet]. Atlanta(GA): CDC; 2013[cited 2020 Jun 5]. Available from: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf
4 Bassetti M, Nicolini L, Esposito S, Righi E, Viscoli C. Current status of newer carbapenems. Current Medicinal Chemistry. 2009;16(5):564-675. https://doi.org/10.2174/092986709787458498   DOI
5 Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. The New England Journal of Medicine. 2010;362(19):1804-13. https://doi.org/10.1056/NEJMra0904124   DOI
6 Kang CI. Antimicrobial therapy for infections caused by multidrug-resistant gram-negative bacteria. The Korean Journal of Medicine. 2015;88(5):502-8. https://doi.org/10.3904/kjm.2015.88.5.502   DOI
7 Korea Centers for Disease Control and Prevention. 2017 Guidelines for health care associated infection(VRSA/CRE) prevention and control. Cheongju: KCDC; 2017.
8 Naas T, Nordmann P. Analysis of a carbapenem-hydrolyzing class a beta-lactamase from enterobacter cloacae and of its LysR-type regulatory protein. Proceedings of National Academy of Sciences of the United States of America. 1994;91(16):7693-7. https://doi.org/10.1073/pnas.91.16.7693   DOI
9 Nordmann P, Naas T, Poirel L. Global spread of carbapenemase-producing enterobacteriaceae. Emerging Infectious Diseases. 2011;17(10):1791-1798. https://doi.org/10.3201/eid1710.110655   DOI
10 Go EB, Ju SJ, Park SD, Yoo JI, Hwang KJ. Distributions of carbapenem-resistant enterobacteriaceae (CRE) in Korea, 2018. PHWR. 2019;12(45):1977-83.
11 Nordmann P, Cuzon G, Naas T. The real threat of klebsiella pneumoniae carbapenemase-producing bacteria. The Lancet Infectious Diseases. 2009;9(4):228-36. https://doi.org/10.1016/S1473-3099(09)70054-4   DOI
12 Bleumin D, Cohen MJ, Moranne O, Esnault VL, Benenson S, Paltiel O, et al. Carbapenem-resistant klebsiella pneumoniae is associated with poor outcome in hemodialysis patients. Journal of Infection. 2012;65(4):318-25. https://doi.org/10.1016/j.jinf.2012.06.005   DOI
13 Jiao Y, Qin Y, Liu J, Li Q, Dong Y, Shang Y, et al. Risk factors for carbapenem-resistant klebsiella pneumoniae infection/colonization and predictors of mortality: a retrospective study. Pathogens and Global Health. 2015;109(2):68-74. https://doi.org/10.1179/2047773215Y.0000000004   DOI
14 Dautzenberg MJ, Wekesa AN, Gniadkowski M, Antoniadou A, Giamarellou H, Petrikkos G L, et al. The association between colonization with carbapenemaseproducing enterobacteriaceae and overall ICU mortality: an observational cohort study. Critical Care Medicine. 2015;43(6):1170-7. https://doi.org/10.1097/CCM.0000000000001028   DOI
15 Shilo S, Assous MV, Lachish T, Kopuit P, Bdolah-Abram T, Yinnon AM, et al. Risk factors for bacteriuria with carbapenem-resistant klebsiella pneumoniae and its impact on mortality: a case-control study. Infection. 2013;41(2):503-9. https://doi.org/10.1007/s15010-012-0380-0   DOI
16 Ling ML, Tee YM, Tan SG, Amin IM, How KB, Tan KY, et al. Risk factors for acquisition of carbapenem resistant enterobacteriaceae in an acute tertiary care hospital in singapore. Antimicrobial Resist Infection Control. 2015;4(1):26. https://doi.org/10.1186/s13756-015-0066-3   DOI
17 Statistics Korea. The korean standard classification of diseases and causes of death, 2020[Internet]. Daejeon: Statistics Korea; 2020[cited 2020 sept 5]. Available from: https://kssc.kostat.go.kr:8443/ksscNew_web/index.jsp
18 Katsiari M, Panagiota G, Likousi S, Roussou Z, Polemis M, Alkiviadis VC, et al. Carbapenem-resistant klebsiella pneumoniae infections in a greek intensive care unit: molecular characterisation and treatment challenges. Jouranl of Global Antimicrob Resistance. 2015;3(2):123-127. https://doi.org/10.1016/j.jgar.2015.01.006   DOI
19 Correa L, Martino MD, Siqueira I, Pasternak J, Gales AC, Silva CV, et al. A hospital-based matched case-control study to identify clinical outcome and risk factors associated with carbapenem-resistant klebsiella pneumoniae infection. BMC Infectious Diseases. 2013;13:80. https://doi.org/10.1186/1471-2334-13-80   DOI
20 Mariappan S, Sekar U, Kamalanathan A. Carbapenemase-producing enterobacteriaceae: risk factors for infection and impact of resistance on outcomes. International Journal of Applied Basic Medical Research. 2017;7(1):32-9. https://doi.org/10.4103/2229-516X.198520   DOI
21 Zhang S, Cui YL, Diao MY, Chen DC, Lin ZF. Use of platelet indices for determining Illness severity and predicting prognosis in critically ill patients. Chinese Medical Journal (Engl). 2015; 128(15):2012-8. https://doi.org/10.4103/0366-6999.161346   DOI
22 Ghoshal K, Bhattacharyya M. Overview of platelet physiology: its hemostatic and nonhemostatic role in disease pathogenesis. The Scientific World Journal. 2014;2014:1-16. https://doi.org/10.1155/2014/781857   DOI
23 Warny M, Helby J, Nordestgaard BG, Birgens H, Bojesen SE. Lymphopenia and risk of infection and infection-related death in 98,344 individuals from a prospective Danish population-based study. PLoS Medicine. 2018;15(11):e1002685. https://doi.org/10.1371/journal.pmed.1002685   DOI
24 Wakabayashi T. Mechanism of the calcium-regulation of muscle contraction-in pursuit of its structural basis. Proceedings of the Japan Academy, Series B. 2015;91(7):321-350. https://doi.org/10.2183/pjab.91.321   DOI
25 Ceccato A, Panagiotarakou M, Ranzani OT, Martin-Fernandez M, Almansa-Mora R, Gabarrus A, et al. Lymphocytopenia as a predictor of mortality in patients with ICU-acquired pneumonia. Journal of Clinical Medicine. 2019;8(6):843. https://doi.org/10.3390/jcm8060843   DOI
26 Julie R, Gooley TA, Richard A, Michael J. Hypocalcemia: a pervasive metabolic abnormality in the critically ill. American Journal of Kidney Diseases. 2001;37(4):689-698. https://doi.org/10.1016/S0272-6386(01)80116-5   DOI
27 Muller B, Becker KL, Kranzlin M, Schachinger H, Huber PR, Nylen ES, et al. Disordered calcium homeostasis of sepsis: association with calcitonin precursors. European Journal of Clinical Investigation. 2000;30(9):823-831. https://doi.org/10.1046/j.1365-2362.2000.00714.x   DOI
28 Moman RN, Gupta N, Sheikh NS, Varacallo M. Physiology, albumin[Internet]. treasure island(FL): statpearls; 2020[cited 2020 Jun 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459198/
29 Kendall H, Abreu E, Cheng AL. Serum albumin trend Is a predictor of mortality in ICU aatients with sepsis. Biological Research For Nursing. 2019;21(3):237-44. https://doi.org/10.1177/1099800419827600   DOI
30 Kang HR, Lee SN, Cho YJ, Jeon JS, Noh H, Han DC, et al. A decrease in serum creatinine after ICU admission is associated with increased mortality. PLoS One. 2017; 12(8):e0183156. https://doi.org/10.1371/journal.pone.0183156   DOI