- 期刊
Temporal Trend of Carbapenem Utilizations in Community-Onset Urinary Tract Infection in Hospitalization in Taiwan (1997-2012): Risk Factor and Mortality Analysis
摘要
Objective: To ascertain whether there is an increased in temporal trend of carbapenem utilization in community-onset urinary tract infection (UTI) in Taiwan which would suggest multidrug resistance and explore some possible mortality risk factors. Methods: We used National Health Insurance Research Database in Taiwan from 1997 to 2012 to identify carbapenem user in inpatients with community onset urinary tract infection. Non-carbapenem user was selected in a matched control group in a 1:10 ratio. We performed a case-control study to compare the comorbidity and mortality. Results: In hospitalized patients with extended spectrum beta lactamase (ESBL) Escherichia coli infection, carbapenem is the drug of choices as definitive therapy. And we found the carbapenem user in community onset urinary tract infection with hospitalization increased rapidly after 2003. And we found diabetes mellitus and beta-lactam or fluoroquinolone use were associated with carbapenem use during hospitalization. Carbapenem use (adjusted hazard ratio (HR): 2.09; 95% confidence interval (CI) 1.18-3.73) was independent associated with Day 90 mortality after adjusting other confounding factors. Other risk factor included cancer (adjusted HR: 2.03; 95% CI: 1.23-3.33). Conclusions: Our nationwide study confirmed the increased temporal trend of carbapenem utilization, which is highly indicative and corresponds very well with the international trend of increased burden of multidrug resistance in community-onset UTI.