Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit

Nicolás Francisco Fernández-Martínez, Sheila Cárcel-Fernández, Carmen De la Fuente-Martos, Rafael Ruiz-Montero, Bernardo R Guzmán-Herrador, Rafael León-López, Francisco Javier Gómez, Julia Guzmán-Puche, Luis Martínez-Martínez, Inmaculada Salcedo-Leal, Nicolás Francisco Fernández-Martínez, Sheila Cárcel-Fernández, Carmen De la Fuente-Martos, Rafael Ruiz-Montero, Bernardo R Guzmán-Herrador, Rafael León-López, Francisco Javier Gómez, Julia Guzmán-Puche, Luis Martínez-Martínez, Inmaculada Salcedo-Leal

Abstract

Multidrug-resistant Gram-negative bacteria (MDR-GNB) are microorganisms that have acquired resistance to extended-spectrum antibacterials and constitute an emerging threat to public health. Although carriers are an important source of transmission in healthcare settings, data about risk factors for MDR-GNB carriage are limited. Therefore, we aimed to identify risk factors for MDR-GNB carriage upon intensive care unit (ICU) admission and to optimise screening strategies. We conducted a case-control study. Admissions of adult patients to the ICU of a 1000-bed hospital during a year were included. We collected sociodemographic, clinical and microbiological data and performed a multivariate logistic regression model. A total of 1342 patients resulted in 1476 episodes of ICU admission, 91 (6.2%) of whom harboured MDR-GNB (38.5% women; median age 63.9 years). The most frequently isolated pathogens were Escherichia coli (57%) and Klebsiella pneumoniae (16%). The most frequent resistance mechanism was production of extended-spectrum beta lactamases. MDR-GNB carriage was associated to liver cirrhosis (OR 6.54, 95% CI 2.17-19.17), previous MDR-GNB carriage (OR 5.34, 1.55-16.60), digestive surgery (OR 2.83, 1.29-5.89) and length of hospital stay (OR 1.01 per day, 1.00-1.03). Several risk factors for MDR-GNB carriage upon admission to a high-risk setting were identified; the main comorbidity was liver cirrhosis.

Keywords: antibacterial drug resistance; critical care; epidemiology; gram negative bacteria; infection control; risk factors.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distribution of the study participants.
Figure 2
Figure 2
ROC (receiver operating characteristic) curve of the logistic regression model.

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