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Article

Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients: A Nested Case–Control Study

1
Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
2
Department of Anesthesia and Intensive Care Medicine Azienda, Universitaria-Ospedaliera Policlinico Umberto I, 00185 Rome, Italy
3
Department of Internal, Anesthesiological and Cardiovascular Clinical Sciences, Sapienza University of Rome, 00185 Rome, Italy
4
Department of General and Specialist Surgery “P. Stefanini”, Sapienza University of Rome, 00185 Rome, Italy
*
Author to whom correspondence should be addressed.
These authors contributed equally.
Academic Editors: Italo Francesco Angelillo and Maria Lina Mezzatesta
Received: 25 January 2021 / Revised: 25 February 2021 / Accepted: 11 March 2021 / Published: 15 March 2021
(This article belongs to the Special Issue Antibiotics Use and Antimicrobial Resistance in Hospital)
Epidemiological research has demonstrated direct relationships between antibiotic consumption and the emergence of multidrug-resistant (MDR) bacteria. In this nested case–control study, we assessed whether prior exposure to antibiotic therapy and its duration affect the onset of healthcare-associated infections (HAIs) sustained by MDR Klebsiella pneumoniae (MDR-Kp) in intensive care unit patients. Cases were defined as patients who developed an MDR-Kp HAI. Controls matched on sex and the length of intensive care unit (ICU) stay were randomly selected from the at-risk population. Any antibiotic agent received in systemic administration before the onset of infection was considered as antibiotic exposure. Multivariable conditional logistic regression analyses were performed to estimate the effect of prior exposure to each antibiotic class (Model 1) or its duration (Model 2) on the onset of HAIs sustained by MDR-Kp. Overall, 87 cases and 261 gender-matched controls were compared. In Model 1, aminoglycosides and linezolid independently increased the likelihood of developing an MDR-Kp HAI, whereas exposure to both linezolid and penicillins reduced the effect of linezolid alone. In Model 2, cumulative exposure to aminoglycosides increased the likelihood of the outcome, as well as cumulative exposures to penicillins and colistin, while a previous exposure to both penicillins and colistin reduced the influence of the two antibiotic classes alone. Our study confirms that aminoglycosides, penicillins, linezolid, and colistin may play a role in favoring the infections sustained by MDR-Kp. However, several double exposures in the time window before HAI onset seemed to hinder the selective pressure exerted by individual agents. View Full-Text
Keywords: healthcare-associated infections; antibiotic exposure; intensive care unit; multidrug resistance; Klebsiella pneumoniae healthcare-associated infections; antibiotic exposure; intensive care unit; multidrug resistance; Klebsiella pneumoniae
MDPI and ACS Style

Migliara, G.; Baccolini, V.; Isonne, C.; Cianfanelli, S.; Di Paolo, C.; Mele, A.; Lia, L.; Nardi, A.; Salerno, C.; Caminada, S.; Cammalleri, V.; Alessandri, F.; Tellan, G.; Ceccarelli, G.; Venditti, M.; Pugliese, F.; Marzuillo, C.; De Vito, C.; De Giusti, M.; Villari, P. Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients: A Nested Case–Control Study. Antibiotics 2021, 10, 302. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10030302

AMA Style

Migliara G, Baccolini V, Isonne C, Cianfanelli S, Di Paolo C, Mele A, Lia L, Nardi A, Salerno C, Caminada S, Cammalleri V, Alessandri F, Tellan G, Ceccarelli G, Venditti M, Pugliese F, Marzuillo C, De Vito C, De Giusti M, Villari P. Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients: A Nested Case–Control Study. Antibiotics. 2021; 10(3):302. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10030302

Chicago/Turabian Style

Migliara, Giuseppe, Valentina Baccolini, Claudia Isonne, Sara Cianfanelli, Carolina Di Paolo, Annamaria Mele, Lorenza Lia, Angelo Nardi, Carla Salerno, Susanna Caminada, Vittoria Cammalleri, Francesco Alessandri, Guglielmo Tellan, Giancarlo Ceccarelli, Mario Venditti, Francesco Pugliese, Carolina Marzuillo, Corrado De Vito, Maria De Giusti, and Paolo Villari. 2021. "Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients: A Nested Case–Control Study" Antibiotics 10, no. 3: 302. https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics10030302

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