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We aimed to assess the clinical impact and potential risk factors associated with polymyxin-resistance Enterobacteriaceae strains isolated from patients hospitalized in adult and neonatal Intensive Care Units. We conducted a case-control study from September/2015 to January/2017. Antimicrobial susceptibility of polymyxin-resistance Enterobacteriaceae strains was determined by broth microdilution. The presence of resistance genes was evaluated by PCR and DNA sequencing. Renal failure (p=0.02; OR 11.37; 95% CI 1.0-128.63), urinary catheter (p<0.01; OR 4.16; 95% CI 38.82-366.07), transference between hospital units (p=0.03; OR 9.98; 95% CI 1.01-98.42), carbapenem use (p<0.01; OR 45.49; 95% CI 6.93-298.62) and surgical procedure (p<0.01; OR 16.52; 95% CI 2.83-96.32) were risk factors for the acquisition of polymyxin-resistant strains in adult patients. For the neonatal patients, central venous catheter (p<0.01; OR 69.59; 95% CI 7.33-660.30) was the only risk factors associated with polymyxin-resistant. Analysis of the outcomes revealed that mortality rate was significantly higher in adults (66.6%) and newborns (23.5%) patients with polymyxin-resistant than those polymyxin-susceptible strains. In addition,carbapenem exposure (p<0.01; OR 50.93; 95% CI 2.26->999.999) were strongly associated with mortality. On the other hand, aminoglycosides use (p<0.03; OR 0.06; 95% CI 0.004-0.97) was a protection factor for mortality by polymyxin-resistant strains. Several risk factors were associated with polymyxin-resistance strains. The high mortality rates showed that acquisition of these strains is a predictor for unfavorable outcomes. Additionally, the therapy of aminoglycosides/polymyxin might be a better combination to improve patient outcomes.

Original publication





International journal of antimicrobial agents

Publication Date



Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grosso do Sul, Brazil.