Healthcare-Associated Infections Caused by Multidrug-Resistant Organisms: Risk Factors, Clinical Outcomes, and Prevention Strategies
DOI:
https://doi.org/10.66687/jebmr.1.01.2025.45Keywords:
healthcare-associated infection, antimicrobial resistance, multidrug-resistant organisms, empirical antimicrobial therapy, septic shock, infection prevention, multicentre cohortAbstract
Background: Multidrug-resistant organisms (MDROs) complicate healthcare-associated infections (HAIs), yet the relationships among antecedent exposures, initial antimicrobial activity, patient outcomes, and prevention-related exposures require careful interpretation among patients already infected. We compared MDR and non-MDR HAIs across eight hospitals in New York, USA.
Methods: This multicentre observational cohort study analysed 650 adults with culture-confirmed HAIs occurring more than 48 hours after admission across eight anonymised hospitals in New York, USA, between January 2024 and June 2024. The primary endpoint was MDR status at the index infection; secondary endpoints included active empirical therapy, septic shock, post-HAI hospital stay, in-hospital death and 30-day all- cause death. Logistic regression models adjusted for clinical covariates and hospital and infection-site indicators; negative-binomial regression assessed post-HAI stay. Associations are presented with 95% confidence intervals (CIs).
Results: Among 650 patients, 193 (29.7%) had MDR HAIs. MDR status was associated with prior antibiotic exposure (adjusted odds ratio [aOR] 2.44, 95% CI 1.64–3.63), documented MDRO colonisation (aOR 4.87, 2.98–7.96), previous hospitalisation (aOR 1.60, 1.10–2.35), and an early central line (aOR 1.76, 1.14–2.73). An admission prevention-bundle indicator was inversely associated with MDR status (aOR 0.45, 0.31–0.66). Active initial therapy occurred in 51.8% of MDR versus 87.1% of non-MDR cases. MDR HAIs were associated with septic shock (aOR 1.68, 1.04– 2.72) and longer post-HAI stay (adjusted incidence-rate ratio 1.37, 1.24–1.50), but not 30-day mortality (aOR 1.06, 0.60–1.85).
Conclusions: Among patients already experiencing HAIs, antecedent antibiotic use and MDRO carriage identified important resistance-associated profiles, while MDR cases experienced substantial treatment mismatch and morbidity. Prevention-bundle associations are noncausal, and mortality differences remained uncertain. Multicentre validation and intervention studies are warranted.
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