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Acquisition of carbapenem-resistant Gram-negative bacilli in intensive care unit: predictors and molecular
P Marchenay1, G Blasco2, J-C Navellou3
1Service d'hygiène hospitalière, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
Objectives:
We had for aim to determine the risk factors for acquiring carbapenem-intermediate or -resistant Gram-negative bacilli (CR-GNB) in an intensive care unit (ICU) and to identify the resistance mechanisms involved.
Patients And Methods:
We conducted an observational prospective cohort study during 6 months in medical and surgical ICUs of the Besançon Teaching Hospital. Patients with acquired CR-GNB were patients whose cultures (screening or diagnosis) became positive more than 48h after admission to the ICU. The risk factors for ICU-acquired CR-GNB were determined by multivariate logistic regression. CR-GNB isolates were typed by pulsed-field gel electrophoresis (PFGE) and screened for resistance mechanisms with phenotypic and genotypic tests.
Results:
Twenty-three of the 347 included patients had acquired a CR-GNB. The multivariate analysis revealed significant associations between this acquisition and the duration of previous treatments with piperacillin-tazobactam (adjusted odds ratio [aOR], 1.13, P=0.02) and aminoglycosides (aOR, 1.62; P=0.005), but not with carbapenems. The CR-GNB strains were identified as Pseudomonas aeruginosa (n=10), Stenotrophomonas maltophilia (n=7), and Enterobacter cloacae (n=6). No acquired carbapenemase-producing strain was identified. PFGE typing identified 1 multiple clone among P. aeruginosa isolates (4 patients), whereas for the other bacteria, all the strains were different.
Conclusion:
Our study results suggest that the strategy to prevent the emergence and spread of CR-GNB should not be limited to the sole restriction of carbapenem use in ICU settings.
Insights
Previous antibiotic use, not carbapenems, increases the risk of acquiring carbapenem-resistant Gram-negative bacilli (CR-GNB) in intensive care units (ICUs). Prevention strategies should broaden beyond carbapenem restriction.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Carbapenem-intermediate or -resistant Gram-negative bacilli (CR-GNB) pose a significant threat in intensive care units (ICUs).
- Understanding risk factors for CR-GNB acquisition is crucial for effective infection control.
Purpose of the Study:
- To identify risk factors associated with acquiring CR-GNB in an ICU setting.
- To characterize the resistance mechanisms present in CR-GNB isolates.
Main Methods:
- An observational prospective cohort study was conducted over six months in medical and surgical ICUs.
- Risk factors were determined using multivariate logistic regression.
- CR-GNB isolates underwent pulsed-field gel electrophoresis (PFGE) and phenotypic/genotypic resistance testing.
Main Results:
- Twenty-three out of 347 patients acquired CR-GNB.
- Acquisition was significantly associated with prior piperacillin-tazobactam and aminoglycoside use, but not carbapenems.
- Predominant CR-GNB included Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Enterobacter cloacae; no carbapenemase-producing strains were found.
Conclusions:
- ICU-acquired CR-GNB risk is linked to specific antibiotic exposures beyond carbapenems.
- Current prevention strategies focusing solely on carbapenem restriction may be insufficient.
- Broader antibiotic stewardship is recommended to combat CR-GNB emergence.
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