Clinical And Economic Impact Of Carbapenems Resistance In Children’s Nonfermenters Sepsis

Carbapenems-resistant nonfermenters infection is a recognized clinical issue and a major public health threat. Infections caused by carbapenems-resistant nonfermenters are believed to result in higher mortality rates, longer hospitalization durations, and higher healthcare costs than infections caused by carbapenems-susceptible bacteria. This research is to investigate the impact of carbapenems resistance on clinical and economic outcomes among hospitalized patients with carbapenems-resistant nonfermenters sepsis.Part1 Clinical Impact of Carbapenems Resistance in Children’s Nonfermenters SepsisObjective:To investigate the impact of carbapenems resistance on clinical outcomes among hospitalized patients with carbapenems-resistant nonfermenters sepsis.Methods:A retrospective, matched case-control(1:1) study was conducted to compare the differences in economic outcomes of patients with carbapenems-resistant nonfermenters sepsis with positive blood cultures and patients with carbapenems –susceptible nonfermenters from 2006.7.1 to 2014.12.31. Case patients were matched to control patients on the basis of sex, age, severity of underlying and acute illness.Results:34 cases with carbapenems-resistant nonfermenters sepsis were eligible for the study and matched with appropriate controls. The number of organs involved and mortality in the study group were significantly higher than those in control group(P < 0.05), while there was no significant difference in respiratory insufficiency, liver dysfunction, renal insufficiency, cardiac insufficiency, mixed infection and the occurrence of shock. 10(29.4%) of he study group received appropriate antibiotic therapy, less than 25(73.5%) of the patients in the control group(P < 0.05). The length of days from infection to receive appropriate antibiotic therapy in study group was 1.83 + 0.66 days,longer than that in the control group, 0.31 + 0.24 days(P < 0.05). The use of carbapenem therapy and antibiotic combination therapy before infection are risk factors of carbapenems-resistant nonfermenters sepsis.The two groups had no statistically significant in the total hospitalization time or the length of ICU stay. The occurrence of MODS and hyperbilirubinemia were death risk factors of nonfermenters sepsis.Conclusions:Patients with carbapenems-resistant nonfermenters sepsis had a higher mortality rate and were less likely to receive appropriate antibiotic therapy than patients with carbapenems –susceptible nonfermenters sepsis. The use of carbapenem therapy and antibiotic combination therapy before infection are risk factors of carbapenems-resistant nonfermenters sepsis. Hyperbilirubinemia and MODS are death risk factors of nonfermenters sepsis.Part2 Economic Impact of Carbapenems Resistance in Children’s Nonfermenters SepsisObjective:To investigate the impact of carbapenems resistance on economic outcomes among hospitalized patients with carbapenems-resistant nonfermenters sepsis.Methods:A retrospective, matched case-control(1:1) study was conducted to compare the differences in economic outcomes of patients with carbapenems-resistant nonfermenters sepsis with positive blood cultures and patients with carbapenems –susceptible nonfermenters from 2006.7.1 to 2014.12.31. Case patients were matched to control patients on the basis of sex, age, severity of underlying and acute illness.Results:34 cases with carbapenems-resistant nonfermenters sepsis were eligible for the study and matched with appropriate controls. Cases and controls had a significantly different costs for diagnosis and treatment. The cost of diagnosis and treatment in the study group were significantly higher than those in control group(68773.39±11105.35 VS 41035.14±6163.36,P =0.034).Conclusions:Patients with carbapenems-resistant nonfermenters sepsis incurred greater charge for diagnosis and treatment than patients with carbapenems –susceptible nonfermenters sepsis.Part3 Clinical Characteristics and Risk Factors of Children’s Pseudomonas Aeruginosa SepsisObjective:To identify characteristics and risk factors of children’s sepsis with positive blood cultures of Pseudomonas aeruginosa.Methods:Clinical and microbiological data were analysed from sepsis patients with positive blood cultures of Pseudomonas aeruginosa from 2006.1 to 2014.6. Variables were analysed using univariate and multiple logistic regression analyses.Results:A total of 55 patients were included in the study,17 cases died, accounting for 30.9%. Variables were analysed using univariate and multiple logistic regression analyses. The PCIS score(OR 47.404,95%CI 3.355-669.817) and anti-pseudomonas aeruginosa antibiotic therapy within 72 hours(OR 13.168,95%CI 1.018-170.346) were associated with mortality.Conclusions:The PCIS score and anti-pseudomonas aeruginosa antibiotic therapy within 72 hours were related to the patients’ outcome. Coverage of P. aeruginosa has largely driven the recommended antibiotic choices for children with underlying disease because of the especially high mortality rates associated with this infection.