External Validation of Difficult-to-Treat Resistance Prevalence and Mortality Risk in Gram-Negative Bloodstream Infection Using Electronic Health Record Data From 140 US Hospitals

Sameer S Kadri; Yi Ling Elaine Lai; Emily E Ricotta; Jeffrey R Strich; Ahmed Babiker; Chanu Rhee; Michael Klompas; John P Dekker; John H Powers 3rd; Robert L Danner; Jennifer Adjemian; NIH Antimicrobial Resistance Outcomes Research Initiative (NIH-ARORI)

doi:10.1093/ofid/ofz110

External Validation of Difficult-to-Treat Resistance Prevalence and Mortality Risk in Gram-Negative Bloodstream Infection Using Electronic Health Record Data From 140 US Hospitals

Open Forum Infect Dis. 2019 Feb 28;6(4):ofz110. doi: 10.1093/ofid/ofz110. eCollection 2019 Apr.

Authors

Affiliations

¹ Critical Care Medicine Department, National Institutes of Health Clinical Center, Bethesda, Maryland.
² Epidemiology Unit, Division of Intramural Research, National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland.
³ United States Public Health Service, Commissioned Corps, Rockville, Maryland.
⁴ Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
⁵ Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.
⁶ Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
⁷ Laboratory of Clinical Immunology and Microbiology, National Institutes of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland.
⁸ Clinical Research Directorate/Clinical Monitoring Research Program, Frederick National Laboratory for Cancer Research, sponsored by the National Cancer Institute.

Abstract

Difficult-to-treat resistance (DTR; ie, co-resistance to all first-line antibiotics) in gram-negative bloodstream infection (GNBSI) is associated with decreased survival in administrative data models. We externally validated DTR prevalence and associated mortality risk in GNBSI using detailed clinical data from electronic health records to adjust for baseline differences in acute illness severity.

Keywords: antimicrobial resistance; gram-negative bacteria; mortality.

Abstract

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