Multi-drug-resistant gram-negative bacterial infection in surgical patients hospitalized in the ICU: a cohort study

Area of Science:

• Infectious Diseases
• Surgical Critical Care
• Microbiology

Background:

• Postoperative infections, particularly those caused by multi-drug-resistant gram-negative bacteria (MDR-GNB), pose a significant threat to surgical patients.
• Identifying modifiable risk factors is crucial for developing effective prevention strategies in intensive care unit (ICU) settings.

Purpose of the Study:

• To identify and quantify risk factors associated with the development of MDR-GNB infections in surgical patients.
• To analyze the impact of operative time, specific therapies, and prior antibiotic exposure on MDR-GNB acquisition.

Main Methods:

• Retrospective cohort study involving surgical patients hospitalized in the ICU for over 5 days.
• Multivariable analysis was employed to adjust for confounders, including the time distribution of infections.
• Comparison between patients who developed MDR-GNB infections and those who did not.

Main Results:

• Increased operative time (OR: 1.007), use of antineoplastic, immunosuppressive, or immunomodulating therapies (OR: 8.9), and daily use of metronidazole (OR: 1.09) or carbapenems (OR: 1.09) were associated with higher odds of MDR-GNB infection.
• Patients receiving antibiotics within 3 months prior to admission had 3.8 times higher odds of acquiring MDR-GNB infections.

Conclusions:

• Potentially modifiable risk factors, including prolonged operative duration and specific medication use, contribute to MDR-GNB infections in critically ill surgical patients.
• Prior antibiotic exposure is a significant predictor of subsequent MDR-GNB infections.
• These findings can inform targeted interventions to reduce the incidence of these challenging infections.