Risk factors for ICU-acquired imipenem-resistant Gram-negative bacterial infections

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Microbiology

Background:

• Intensive care units (ICUs) are critical environments where patients are susceptible to healthcare-associated infections.
• Antibiotic-resistant bacteria pose a significant threat in ICUs, complicating patient management and increasing morbidity.
• Gram-negative infections, particularly those resistant to carbapenems like imipenem, are a growing concern.

Purpose of the Study:

• To identify and analyze the risk factors associated with the acquisition of imipenem-resistant Gram-negative infections within ICUs.
• To differentiate risk factors for imipenem-resistant versus imipenem-sensitive Gram-negative infections in the ICU setting.

Main Methods:

• A prospective study was conducted in surgical and medical ICUs between April and December 2002.
• Data were collected on patients who developed Gram-negative infections during their ICU stay.
• Univariate and multivariate analyses were performed to determine significant risk factors for imipenem resistance.

Main Results:

• Out of 128 Gram-negative infections, 42 were imipenem-resistant and 86 were imipenem-sensitive.
• Univariate analysis indicated that prior hospital stay, length of ICU stay, surgical ICU admission, surgery, and previous antibiotic use were risk factors.
• Multivariate analysis revealed that length of ICU stay, surgical operations, and previous carbapenem use were independent risk factors for imipenem resistance.

Conclusions:

• Prolonged ICU stay, undergoing surgery, and previous exposure to carbapenems are significant independent risk factors for imipenem-resistant Gram-negative infections in the ICU.
• These findings highlight the need for targeted infection control strategies and antibiotic stewardship in high-risk ICU patients.