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Prevalence and risk factors for colonisation with gram-negative bacteria in an intensive care unit
1Department of Intensive Care, Ghent University Hospital, Belgium. icu@rug.ac.be
Insights
Gram-negative bacteria colonization is common in ICU patients, especially those on mechanical ventilation or with longer stays. High APACHE II scores indicate increased risk, necessitating enhanced precautions to prevent infection.
Area of Science:
- Intensive Care Medicine
- Infectious Diseases
- Microbiology
Background:
- Gram-negative bacteria colonization poses a significant threat in intensive care units (ICUs).
- Identifying risk factors is crucial for effective prevention strategies in critically ill patients.
Purpose of the Study:
- To determine the prevalence of Gram-negative bacteria colonization in ICU patients.
- To identify key risk factors associated with this colonization.
Main Methods:
- A prospective surveillance study was conducted in a 26-bed surgical and pediatric ICU.
- 159 patients were monitored via oral swabs, urine samples, tracheal aspirates (if on mechanical ventilation), and anal swabs.
- Microbiological monitoring occurred thrice weekly for oral/urine and weekly for anal swabs.
Main Results:
- 32.1% of patients acquired Gram-negative bacteria colonization, increasing with ICU length of stay.
- Higher APACHE II scores and the use of mechanical ventilation (MV) were significantly associated with increased colonization risk (p < 0.01).
- 47% of colonizations involved multidrug-resistant strains, and ICU mortality was 8% (adults) and 4% (pediatrics).
Conclusions:
- Patients with high APACHE II scores, requiring mechanical ventilation, and with ICU stays exceeding 3 days are at the highest risk.
- These high-risk patients require stringent precautions to prevent Gram-negative bacteria colonization and subsequent infections.
- Early identification and targeted interventions are essential for improving outcomes in critically ill patients.
Objective:
To investigate prevalence and determine risk factors for colonisation with Gram-negative bacteria in ICU patients.
Design:
Prospective, surveillance study.
Setting:
26-bed surgical and paediatric ICU.
Patients:
159 patients--whereof 22 infants--admitted to the surgical/paediatric ICU over a two-month period.
Intervention:
In all patients routine microbiological monitoring was performed by thrice weekly oral swabs, urine sampling and, additionally, tracheal aspirates in patients on mechanical ventilation (MV) and by anal swabs once weekly.
Results:
Population characteristics: Mean age of the adult population was 51.1 +/- 17.6 year. Mean age of the paediatric population was 6.3 +/- 5.3 year. The mean APACHE II-score was 18 +/- 9.1. The mean PRISM-score was 9.7 +/- 5.4. The mean ICU stay was 7.5 +/- 11.4 days. 43.4 percent of patients received mechanical ventilation (MV). The mean number of mechanical ventilation days was 11.1 +/- 14.7 days. 32.1% of patients experienced colonisation with Gram-negative bacteria. Prevalence of colonisation increased with length of ICU stay. The probability of colonisation was 24% after an ICU stay of 3 days (= median ICU stay). Time to colonisation was not different between the controlled sites (p > 0.05). 47% of colonizations were due to multiresistant strains. Higher APACHE II-scores and MV were associated with a higher prevalence of colonisation (p < 0.01). The ICU mortality was 8% among adult and 4% among paediatric patients.
Conclusion:
Patients with high APACHE II-scores, on mechanical ventilation and with an ICU stay of more than 3 days are most at risk for colonisation with Gram-negative bacteria. These patients should be cared with the optimal precautions in the prevention of colonisation and infection.