A Multicenter, Prospective, Observational Study to Determine Predictive Factors for Multidrug-Resistant Pneumonia in Critically Ill Adults: The DEFINE Study

doi:10.1002/phar.2171

A Multicenter, Prospective, Observational Study to Determine Predictive Factors for Multidrug-Resistant Pneumonia in Critically Ill Adults: The DEFINE Study

Pharmacy Practice and Science

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21 Scopus citations

Abstract

Objective: This study was conducted to describe the prevalence, epidemiology, and clinical outcomes of multidrug-resistant (MDR) organism (MDRO) pneumonia in critically ill patients. Methods: A multicenter, prospective, observational study of patients admitted to 60 intensive care units (ICUs), from 34 hospitals, in the United States from November to December 2016. Adults (> 18 yrs) receiving antimicrobial therapy at least 5 days for pneumonia were included. Patients were classified into two categories, with or without MDRO, and subcategorized by pneumonia type. Measurements and main results: Demographics, medication histories, and health care exposure were collected during ICU admission and compared using t test and chi-square tests. Multivariate logistic regression was used to determine predictive factors for MDRO pneumonia and hospital mortality. Of 652 patients, 92 patients (14.1%) developed MDR pneumonia. Predictors of MDRO pneumonia were acid suppression therapy within the previous 90 days (odds ratio [OR] 1.88 [1.14–3.09]; p=0.013), mechanical ventilation (OR 1.96 [1.14–3.35]; p<0.001), and history of MDRO infection (OR 4.74 [2.21–10.18]; p<0.001). Appropriate initial antimicrobial selection occurred in 58 patients (63%) with MDRO pneumonia compared to 464 patients (82.7%) in patients without MDRO pneumonia (p<0.001). MDRO pneumonia was not associated with hospital mortality (18.5% vs 17.6%, p=0.087). Conclusions: In a broad cohort of critically ill patients, MDRO pneumonia is infrequent, and associated with factors describing the intensity of health care provided. Presence of MDRO pneumonia is not associated with hospital mortality. Further study is needed to clarify risk factors for multidrug-resistant pneumonia in critically ill patients.

Original language	English
Pages (from-to)	253-260
Number of pages	8
Journal	Pharmacotherapy
Volume	39
Issue number	3
DOIs	https://doi.org/10.1002/phar.2171
State	Published - Mar 2019

Bibliographical note

Publisher Copyright:
© 2018 Pharmacotherapy Publications, Inc.

Funding

Writing committee members for the DEFINE study group: Ishaq Lat, Rush University Medical Center, Chicago, IL; Mitchell J. Daley, Dell Seton Medical Center, Austin, TX; Anand J. Shewale, University of Arkansas for Medical Sciences, Little Rock, AR; Mark H. Pangrazzi, Detroit Medical Center – Sinai Grace Hospital, Detroit, MI; Drayton Hammond, Rush University Medical Center, Chicago, IL; and Keith M. Olsen, University of Arkansas for Medical Sciences, Little Rock, AR. Collaborators - site investigators: University of Arkansas for Medical Sciences: Drayton A. Hammond, Keith M. Olsen (Little Rock, AR). Hartford Healthcare: Colleen Teevan (Hartford, CT). University of Florida, Jacksonville: Michael Erdman (Jacksonville, FL). Cleveland Clinic, Florida: Lori Milicevic (Jacksonville, FL). Memorial University Medical Center: Stephanie Hyche (Savannah, GA). Kootenai Health: John Woolridge (Cour d'Alene, ID). Rush University Medical Center: Ishaq Lat, Gourang Patel, Joshua DeMott, Kaitlyn Dalton (Chicago, IL). University of Chicago Medical Center: Sarah Sokol, Pharm.D.; Heather Bullard, Pharm.D.; Mary K. Miller, Pharm.D. (Chicago, IL). Roudebush Veterans Affairs Hospital: Tamra Pierce, Pharm.D. (Indianapolis, IN). University of Kentucky Medical Center: Alexander H. Flannery, Brittany D. Bissell, Melissa L. Thompson Bastin (Lexington, KY). Ochsner Medical Center: Katherine Jennings (New Orleans, LA). Brigham and Women's Hospital: Megan E. Barra, Jeremy R. Degrado, James F. Gilmore, Mary P. Kovacevic, James W. Schurr, Paul Szumita (Boston, MA). Massachusetts General Hospital: Lin Hsin, Natasha Lopez, Danielle Evans (Boston, MA). Beaumont Health: Jenna Holzhausen (Royal Oak, MI). Spectrum Health: Calvin Ice (Grand Rapids, MI). Detroit Medical Center: Mark H. Pangrazzi, Raymond Yost (Detroit, MI). Northeast Regional Medical Center: Jerrod D. Zimmer (Kirksville, MO). Lakes Region Medical Center: Michael P. Smith (Laconia, NH). New Hanover Regional Medical Center: Lisa H. Zimmerman (New Hanover, NC). Wake Forest Baptist Hospital: Michael P. Kenes (Winston-Salem, NC). Hackensack University Medical Center: Justin Kaplan (Hackensack, NJ). University of Rochester Medical Center: Samantha Delibert (Rochester, NY). Cleveland Clinic Foundation: Heather Torbich, Alyssa Chen, Stephanie Bass, Mollie Gowan, Nicole Palm, Gretchen Sacha, Seth Bauer, Sarah Welch (Cleveland, OH). Mercy Medical Center: Matthew Reale (Canton, OH). Allegheny General Hospital: Lauren Finoli (Allegheny, PA). Vanderbilt University Medical Center: Joanna L. Stollings, Susan E. Hamblin, Kelli A. Rimbaugh, Susan E. Smith (Nashville, TN). Roper St. Francis Healthcare: Holly Balcer (Charleston, SC). Dell Seton Medical Center: Mitchell J. Daley (Austin, TX). Memorial Hermann Medical Center: Jennifer Cortes (Houston, TX). Froedtert Hospital: Sara Revolinski, Sarah Peppard (Milwaukee, WI). University of Wisconsin Medical Center: Jeffrey Fish (Madison, WI).

Funders	Funder number
Joshua DeMott
Kaitlyn Dalton
Rush University Medical Center
University of Kentucky Medical Center
University of Wisconsin Medical Center
Cleveland Clinic Foundation General Clinical Research Center of the Cleveland Clinic/Case Western Reserve University
Cleveland Clinic Foundation
Florida AandM University and Florida State University
University of Rochester Medical Center

Keywords

bacterial resistance
critical care
infectious disease

ASJC Scopus subject areas

Pharmacology (medical)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1002/phar.2171

Cite this

@article{2722f258b3b54a54835c557a2cf9b046,

title = "A Multicenter, Prospective, Observational Study to Determine Predictive Factors for Multidrug-Resistant Pneumonia in Critically Ill Adults: The DEFINE Study",

abstract = "Objective: This study was conducted to describe the prevalence, epidemiology, and clinical outcomes of multidrug-resistant (MDR) organism (MDRO) pneumonia in critically ill patients. Methods: A multicenter, prospective, observational study of patients admitted to 60 intensive care units (ICUs), from 34 hospitals, in the United States from November to December 2016. Adults (> 18 yrs) receiving antimicrobial therapy at least 5 days for pneumonia were included. Patients were classified into two categories, with or without MDRO, and subcategorized by pneumonia type. Measurements and main results: Demographics, medication histories, and health care exposure were collected during ICU admission and compared using t test and chi-square tests. Multivariate logistic regression was used to determine predictive factors for MDRO pneumonia and hospital mortality. Of 652 patients, 92 patients (14.1%) developed MDR pneumonia. Predictors of MDRO pneumonia were acid suppression therapy within the previous 90 days (odds ratio [OR] 1.88 [1.14–3.09]; p=0.013), mechanical ventilation (OR 1.96 [1.14–3.35]; p<0.001), and history of MDRO infection (OR 4.74 [2.21–10.18]; p<0.001). Appropriate initial antimicrobial selection occurred in 58 patients (63%) with MDRO pneumonia compared to 464 patients (82.7%) in patients without MDRO pneumonia (p<0.001). MDRO pneumonia was not associated with hospital mortality (18.5% vs 17.6%, p=0.087). Conclusions: In a broad cohort of critically ill patients, MDRO pneumonia is infrequent, and associated with factors describing the intensity of health care provided. Presence of MDRO pneumonia is not associated with hospital mortality. Further study is needed to clarify risk factors for multidrug-resistant pneumonia in critically ill patients.",

keywords = "bacterial resistance, critical care, infectious disease",

author = "Ishaq Lat and Daley, {Mitchell J.} and Anand Shewale and Pangrazzi, {Mark H.} and Drayton Hammond and Olsen, {Keith M.} and Colleen Teevan and Michael Erdman and Lori Milicevic and Stephanie Hyche and John Woolridge and Gourang Patel and Joshua DeMott and Kaitlyn Dalton and Sarah Sokol and Heather Bullard and Miller, {Mary K.} and Tamra Pierce and Flannery, {Alexander H.} and Bissell, {Brittany D.} and {Thompson Bastin}, {Melissa L.} and Katherine Jennings and Barra, {Megan E.} and Degrado, {Jeremy R.} and Gilmore, {James F.} and Kovacevic, {Mary P.} and Schurr, {James W.} and Paul Szumita and Lin Hsin and Natasha Lopez and Danielle Evans and Jenna Holzhausen and Calvin Ice and Raymond Yost and Zimmer, {Jerrod D.} and Smith, {Michael P.} and Zimmerman, {Lisa H.} and Kenes, {Michael P.} and Justin Kaplan and Samantha Delibert and Heather Torbich and Alyssa Chen and Stephanie Bass and Mollie Gowan and Nicole Palm and Gretchen Sacha and Seth Bauer and Sarah Welch and Matthew Reale and Lauren Finoli",

note = "Publisher Copyright: {\textcopyright} 2018 Pharmacotherapy Publications, Inc.",

year = "2019",

month = mar,

doi = "10.1002/phar.2171",

language = "English",

volume = "39",

pages = "253--260",

number = "3",

}

TY - JOUR

T1 - A Multicenter, Prospective, Observational Study to Determine Predictive Factors for Multidrug-Resistant Pneumonia in Critically Ill Adults

T2 - The DEFINE Study

AU - Lat, Ishaq

AU - Daley, Mitchell J.

AU - Shewale, Anand

AU - Pangrazzi, Mark H.

AU - Hammond, Drayton

AU - Olsen, Keith M.

AU - Teevan, Colleen

AU - Erdman, Michael

AU - Milicevic, Lori

AU - Hyche, Stephanie

AU - Woolridge, John

AU - Patel, Gourang

AU - DeMott, Joshua

AU - Dalton, Kaitlyn

AU - Sokol, Sarah

AU - Bullard, Heather

AU - Miller, Mary K.

AU - Pierce, Tamra

AU - Flannery, Alexander H.

AU - Bissell, Brittany D.

AU - Thompson Bastin, Melissa L.

AU - Jennings, Katherine

AU - Barra, Megan E.

AU - Degrado, Jeremy R.

AU - Gilmore, James F.

AU - Kovacevic, Mary P.

AU - Schurr, James W.

AU - Szumita, Paul

AU - Hsin, Lin

AU - Lopez, Natasha

AU - Evans, Danielle

AU - Holzhausen, Jenna

AU - Ice, Calvin

AU - Yost, Raymond

AU - Zimmer, Jerrod D.

AU - Smith, Michael P.

AU - Zimmerman, Lisa H.

AU - Kenes, Michael P.

AU - Kaplan, Justin

AU - Delibert, Samantha

AU - Torbich, Heather

AU - Chen, Alyssa

AU - Bass, Stephanie

AU - Gowan, Mollie

AU - Palm, Nicole

AU - Sacha, Gretchen

AU - Bauer, Seth

AU - Welch, Sarah

AU - Reale, Matthew

AU - Finoli, Lauren

PY - 2019/3

Y1 - 2019/3

N2 - Objective: This study was conducted to describe the prevalence, epidemiology, and clinical outcomes of multidrug-resistant (MDR) organism (MDRO) pneumonia in critically ill patients. Methods: A multicenter, prospective, observational study of patients admitted to 60 intensive care units (ICUs), from 34 hospitals, in the United States from November to December 2016. Adults (> 18 yrs) receiving antimicrobial therapy at least 5 days for pneumonia were included. Patients were classified into two categories, with or without MDRO, and subcategorized by pneumonia type. Measurements and main results: Demographics, medication histories, and health care exposure were collected during ICU admission and compared using t test and chi-square tests. Multivariate logistic regression was used to determine predictive factors for MDRO pneumonia and hospital mortality. Of 652 patients, 92 patients (14.1%) developed MDR pneumonia. Predictors of MDRO pneumonia were acid suppression therapy within the previous 90 days (odds ratio [OR] 1.88 [1.14–3.09]; p=0.013), mechanical ventilation (OR 1.96 [1.14–3.35]; p<0.001), and history of MDRO infection (OR 4.74 [2.21–10.18]; p<0.001). Appropriate initial antimicrobial selection occurred in 58 patients (63%) with MDRO pneumonia compared to 464 patients (82.7%) in patients without MDRO pneumonia (p<0.001). MDRO pneumonia was not associated with hospital mortality (18.5% vs 17.6%, p=0.087). Conclusions: In a broad cohort of critically ill patients, MDRO pneumonia is infrequent, and associated with factors describing the intensity of health care provided. Presence of MDRO pneumonia is not associated with hospital mortality. Further study is needed to clarify risk factors for multidrug-resistant pneumonia in critically ill patients.

AB - Objective: This study was conducted to describe the prevalence, epidemiology, and clinical outcomes of multidrug-resistant (MDR) organism (MDRO) pneumonia in critically ill patients. Methods: A multicenter, prospective, observational study of patients admitted to 60 intensive care units (ICUs), from 34 hospitals, in the United States from November to December 2016. Adults (> 18 yrs) receiving antimicrobial therapy at least 5 days for pneumonia were included. Patients were classified into two categories, with or without MDRO, and subcategorized by pneumonia type. Measurements and main results: Demographics, medication histories, and health care exposure were collected during ICU admission and compared using t test and chi-square tests. Multivariate logistic regression was used to determine predictive factors for MDRO pneumonia and hospital mortality. Of 652 patients, 92 patients (14.1%) developed MDR pneumonia. Predictors of MDRO pneumonia were acid suppression therapy within the previous 90 days (odds ratio [OR] 1.88 [1.14–3.09]; p=0.013), mechanical ventilation (OR 1.96 [1.14–3.35]; p<0.001), and history of MDRO infection (OR 4.74 [2.21–10.18]; p<0.001). Appropriate initial antimicrobial selection occurred in 58 patients (63%) with MDRO pneumonia compared to 464 patients (82.7%) in patients without MDRO pneumonia (p<0.001). MDRO pneumonia was not associated with hospital mortality (18.5% vs 17.6%, p=0.087). Conclusions: In a broad cohort of critically ill patients, MDRO pneumonia is infrequent, and associated with factors describing the intensity of health care provided. Presence of MDRO pneumonia is not associated with hospital mortality. Further study is needed to clarify risk factors for multidrug-resistant pneumonia in critically ill patients.

KW - bacterial resistance

KW - critical care

KW - infectious disease

UR - http://www.scopus.com/inward/record.url?scp=85054312441&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054312441&partnerID=8YFLogxK

U2 - 10.1002/phar.2171

DO - 10.1002/phar.2171

M3 - Article

C2 - 30101412

AN - SCOPUS:85054312441

SN - 0277-0008

VL - 39

SP - 253

EP - 260

JO - Pharmacotherapy

JF - Pharmacotherapy

IS - 3

ER -

A Multicenter, Prospective, Observational Study to Determine Predictive Factors for Multidrug-Resistant Pneumonia in Critically Ill Adults: The DEFINE Study

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

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