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Báo cáo khoa học: "Antimicrobial resistance and patient outcomes: the hazards of adjustment"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Antimicrobial resistance and patient outcomes: the hazards of adjustment. | Available online http ccforum.eom content 10 5 164 Commentary Antimicrobial resistance and patient outcomes the hazards of adjustment Mitchell J Schwaber and Yehuda Carmeli Division of Epidemiology Tel Aviv Sourasky Medical Center Tel Aviv Israel Corresponding author Mitchell J Schwaber mitchells@tasmc.health.gov.il Published 5 September 2006 This article is online at http ccforum.com content 10 5 164 2006 BioMed Central Ltd Critical Care 2006 10 164 doi 10.1186 cc5019 See related research by Zavascki et al. http ccforum.com content 10 4 R114 Abstract Outcomes studies of infections with resistant bacteria often do not account appropriately for intermediate variables - events in the causal pathway between the exposure and the outcome - when controlling for confounders. We discuss how failure to distinguish between confounders and intermediate variables can bias the analysis and we address methods of approaching this issue. Antimicrobial resistance in invasive infections is associated with adverse outcomes including increased mortality increased length of stay and increased hospital costs 1-4 . A number of reasons have been suggested for this observation a delay in institution of effective therapy inferior definitive therapy as compared with that available for susceptible bacteria and greater virulence of some resistant strains 3-5 . Pseudomonas aeruginosa although inherently resistant to numerous antibiotics appears to be no exception to this phenomenon a number of studies have demonstrated an association between still broader resistance and mortality in infections caused by this pathogen 6 7 . In the previous issue of Critical Care Zavascki and colleagues report the results of a prospective cohort study of mortality associated with hospital-acquired pneumonia caused by P. aeruginosa 8 . The authors looked specifically at the effect on outcome of the production of metallo-p-lactamase MBL a group of carbapenamases that hydrolyze all p-lactam antibiotics with the .