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

• Published in: International journal of environmental research and public health Vol. 19; no. 3; p. 1039
• Main Authors: Fernández-Martínez, Nicolás Francisco, Cárcel-Fernández, Sheila, De la Fuente-Martos, Carmen, Ruiz-Montero, Rafael, Guzmán-Herrador, Bernardo R, León-López, Rafael, Gómez, Francisco Javier, Guzmán-Puche, Julia, Martínez-Martínez, Luis, Salcedo-Leal, Inmaculada
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 18-01-2022; MDPI
• Subjects: Adult; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antimicrobial agents; Bacteria; Cancer therapies; Case-Control Studies; Chemotherapy; Cirrhosis; Cross Infection - microbiology; Diabetes; Drug Resistance, Multiple, Bacterial; E coli; Epidemiology; Female; Gastrointestinal surgery; Gram-Negative Bacteria; Gram-Negative Bacterial Infections - epidemiology; Gram-Negative Bacterial Infections - microbiology; Health care; Health risks; Hospitals; Humans; Infections; Intensive care; Intensive Care Units; Klebsiella; Laboratories; Liver; Liver cirrhosis; Long term health care; Male; Microorganisms; Middle Aged; Multidrug resistance; Multidrug resistant organisms; Multivariate analysis; Pathogens; Patient admissions; Patients; Public health; Resistance factors; Risk analysis; Risk Factors; Sociodemographics; Variables; critical care; gram negative bacteria; epidemiology; risk factors; infection control; antibacterial drug resistance
• ISSN: 1660-4601; 1661-7827; 1660-4601
• DOI: 10.3390/ijerph19031039

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
(57%) and
(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.