Spectrum, dose, and duration of antibiotic exposure and risk of intensive care unit–acquired carbapenem-resistant gram-negative bacteria: a prospective cohort study
Authors' conclusion
This study identifies ASI per antibiotic day as the principal independent risk factor for ICU-acquired CR-GNB, significantly outweighing the adjusted impact of DDDs or LOT.
Study context
- Population
- Consecutive adults admitted to 4 ICUs at a university hospital, March 2024–January 2025, screened for Carbapenem-resistant Gram-negative bacteria (CR-GNB) on admission and weekly
- Participants
- 422 adults
- Exposure
- Antibiotic exposure by spectrum, dose and duration
- Outcome
- ICU-acquired carbapenem-resistant gram-negative bacteria (CR-GNB)
Methodological detailsconsecutive enrolment, 4 ICUs, single university hospital, interval-censored Cox regression, restricted cubic splines, relative importance analysis
- Consecutive enrolment
- 4 ICUs, single university hospital
- Interval-censored Cox regression
- Restricted cubic splines
- Relative importance analysis
Main finding
As reported in the abstract
Patients acquiring CR-GNB during ICU stay
151 of 422 patients
35.8%
ASI per antibiotic day, aHR per 1-unit increase (95% CI 1.09-1.19; P < 0.001); J-shaped, P for nonlinearity = 0.027
1.14
DDDs, aHR per 1-unit increase (95% CI 0.69-1.15; P = 0.374); inverted U-shaped, P for nonlinearity < 0.001
0.89
LOT, aHR per 1-day increase (95% CI 0.97-1.11; P = 0.214); non-linear rising trend, P for nonlinearity < 0.001
1.03
Observational data: associations, not effects.
Original publication
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