Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Patient Selection
2.3. Measurements
2.4. Statistical Analysis
3. Results
3.1. Demographic Data
3.2. Analysis of the Risk of Developing CDI with Interactions between MV Support and Carbapenem Therapy
3.3. Analysis of Synergistic Interactions between the Duration of MV Assistance and Carbapenem Therapy for CDI
4. Discussion
Limitations
5. Conclusions
Author Contributions
Acknowledgments
Conflicts of Interest
Abbreviations
CDI | Clostridium difficile infection |
NICUD | National Intensive Care Unit Database |
MV | mechanical ventilation |
References
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Characteristic | Total (n = 267,871) | MV (n = 254,882) | Non-MV (n = 12,989) | p |
---|---|---|---|---|
Age (years): mean ± SD | 68.8 ± 16.7 | 69.1 ± 16.5 | 63.7 ± 19.6 | <0.0001 |
18–64 | 87,675 (32.73) | 82,120 (32.22) | 5555 (42.77) | <0.0001 |
65–74 | 61,383 (22.92) | 58,616 (23.00) | 2767 (21.30) | |
≥75 | 118,813 (44.35) | 114,146 (44.78) | 4667 (35.93) | |
Gender | ||||
Female | 102,217 (38.16) | 96,574 (37.89) | 5643 (43.44) | <0.0001 |
Male | 165,654 (61.84) | 158,308 (62.11) | 7346 (56.56) | |
Carbapenem in ICU † | 79,779 (29.78) | 78,397 (30.76) | 1382 (10.64) | <0.0001 |
ICU duration (days): median (IQR) | 10 (6–17) | 11 (6–17) | 2 (1–5) | <0.0001 |
Comorbidities | ||||
Congestive heart failure | 15,687 (5.86) | 15,037 (5.90) | 650 (5.00) | <0.0001 |
Cerebrovascular accident | 27,633 (10.32) | 26,331 (10.33) | 1302 (10.02) | 0.2621 |
Chronic obstructive pulmonary disease | 43,935 (16.40) | 42,181 (16.55) | 1754 (13.50) | <0.0001 |
Liver disease | 20,097 (7.50) | 18,935 (7.43) | 1162 (8.95) | <0.0001 |
Chronic kidney disease | 12,706 (4.74) | 12,110 (4.75) | 596 (4.59) | 0.3948 |
CCI: mean ± SD | 1.9 ± 2.2 | 1.9 ± 2.2 | 1.7 ± 2.1 | <0.0001 |
0 | 85,527 (31.93) | 80,483 (31.58) | 5044 (38.83) | <0.0001 |
1–2 | 104,476 (39.00) | 99,834 (39.17) | 4642 (35.74) | |
≥3 | 77,868 (29.07) | 74,565 (29.25) | 3303 (25.43) | |
Hospital mortality | 90,918 (33.94) | 86,642 (33.99) | 4276 (32.92) | 0.0118 |
1-year mortality | 157,846 (58.93) | 151,002 (59.24) | 6844 (52.69) | <0.0001 |
Clostridium difficile infection ‡ | 435 (0.16) | 426 (0.17) | 9 (0.07) | 0.0069 |
Variables | Total | Events | (%) | AHR * | (95% CI) | p |
---|---|---|---|---|---|---|
Age (years): mean ± SD | ||||||
18–64 | 87,675 | 104 | (0.12%) | 1.00 | (Reference) | - |
65–74 | 61,383 | 100 | (0.16%) | 1.20 | (0.91–1.59) | 0.2001 |
≥75 | 118,813 | 231 | (0.19%) | 1.43 | (1.12–1.83) | 0.0041 |
Gender | ||||||
Female | 102,217 | 172 | (0.17%) | 1.00 | (Reference) | - |
Male | 165,654 | 263 | (0.16%) | 0.95 | (0.78–1.16) | 0.6235 |
MV Support Duration (days) | ||||||
None | 12,989 | 9 | (0.07%) | 1.00 | (Reference) | - |
7–14 | 97,529 | 126 | (0.13%) | 1.63 | (0.83–3.20) | 0.1595 |
15–21 | 52,068 | 67 | (0.13%) | 1.52 | (0.76–3.06) | 0.2377 |
22–28 | 35,264 | 73 | (0.21%) | 2.34 | (1.17–4.68) | 0.0168 |
29–60 | 70,021 | 160 | (0.23%) | 2.39 | (1.21–4.69) | 0.0117 |
Carbapenem Therapy Duration (days) | ||||||
None | 188,092 | 233 | (0.12%) | 1.00 | (Reference) | - |
1–7 | 3678 | 11 | (0.30%) | 2.02 | (1.10–3.10) | 0.0227 |
8–14 | 10,616 | 15 | (0.14%) | 1.19 | (0.72–2.01) | 0.5117 |
≥15 | 65,485 | 176 | (0.27%) | 1.88 | (1.54–2.30) | <.0001 |
Comorbidities | ||||||
CHF | 15,687 | 35 | (0.22%) | 1.14 | (0.80–1.63) | 0.4676 |
CVA | 27,633 | 53 | (0.19%) | 0.93 | (0.69–1.25) | 0.6116 |
COPD | 43,935 | 79 | (0.18%) | 0.88 | (0.68–1.14) | 0.3378 |
Liver disease | 20,097 | 34 | (0.17%) | 1.05 | (0.73–1.51) | 0.7896 |
CKD | 12,706 | 33 | (0.26%) | 1.38 | (0.95–2.02) | 0.0902 |
CCI | ||||||
0 | 85,527 | 89 | (0.10%) | 1.00 | (Reference) | - |
1–2 | 104,476 | 192 | (0.18%) | 1.62 | (1.24–2.10) | 0.0004 |
≥3 | 77,868 | 154 | (0.20%) | 1.65 | (1.22–2.24) | 0.0012 |
Variables | n | Events | (%) | AHR * | (95% CI) | p |
---|---|---|---|---|---|---|
Carbapenem | ||||||
No | 188,092 | 233 | (0.12%) | 1.00 | (Reference) | - |
Yes | 79,779 | 202 | (0.25%) | 1.92 | (1.59–2.32) | <0.0001 |
Mechanical Ventilation | ||||||
No | 12,989 | 9 | (0.07%) | 1.00 | (Reference) | - |
Yes | 254,882 | 426 | (0.17%) | 2.19 | (1.13–4.24) | 0.0199 |
MV Support Duration (days) | ||||||
None | 12,989 | 9 | (0.07%) | 1.00 | (Reference) | - |
7–14 | 97,529 | 126 | (0.13%) | 1.76 | (0.90–3.46) | 0.1013 |
15–21 | 52,068 | 67 | (0.13%) | 1.73 | (0.86–3.48) | 0.1219 |
22–28 | 35,264 | 73 | (0.21%) | 2.72 | (1.36–5.44) | 0.0046 |
29–60 | 70,021 | 160 | (0.23%) | 2.85 | (1.46–5.58) | 0.0023 |
MV, Carbapenem | ||||||
No MV, no carbapenem | 11,607 | 7 | (0.06%) | 1.00 | (Reference) | - |
No MV, carbapenem | 1382 | 2 | (0.14%) | 1.99 | (0.41–9.60) | 0.3898 |
MV, no carbapenem | 176,485 | 226 | (0.13%) | 1.94 | (0.91–4.11) | 0.0857 |
MV, carbapenem | 78,397 | 200 | (0.26%) | 3.64 | (1.71–7.75) | 0.0008 |
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Chiang, S.-R.; Lai, C.-C.; Ho, C.-H.; Chen, C.-M.; Chao, C.-M.; Wang, J.-J.; Cheng, K.-C. Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients. J. Clin. Med. 2018, 7, 224. https://doi.org/10.3390/jcm7080224
Chiang S-R, Lai C-C, Ho C-H, Chen C-M, Chao C-M, Wang J-J, Cheng K-C. Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients. Journal of Clinical Medicine. 2018; 7(8):224. https://doi.org/10.3390/jcm7080224
Chicago/Turabian StyleChiang, Shyh-Ren, Chih-Cheng Lai, Chung-Han Ho, Chin-Ming Chen, Chien-Ming Chao, Jhi-Joung Wang, and Kuo-Chen Cheng. 2018. "Prolonged Mechanical Ventilation Assistance Interacts Synergistically with Carbapenem for Clostridium difficile Infection in Critically Ill Patients" Journal of Clinical Medicine 7, no. 8: 224. https://doi.org/10.3390/jcm7080224