Prospective observational study of prior rectal colonization status as a predictor for subsequent development of
Silvia Gómez-Zorrilla1, Mariana Camoez2, Fe Tubau2
1Infectious Diseases Service, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.
Abstract:
The potential role of Pseudomonas aeruginosa (PA) intestinal colonization in the subsequent development of infections has not been thoroughly investigated. The aims of this study were to assess the role of PA intestinal colonization as a predictor of subsequent infections and to investigate the risk factors associated with the development of PA infection in patients in the intensive care unit (ICU). For this purpose, a prospective study was conducted that included (i) active surveillance of PA rectal colonization at ICU admission and weekly until ICU discharge, (ii) detection of PA clinical infections, and (iii) genotypic analysis by pulsed-field gel electrophoresis (PFGE). A total of 414 patients were included, of whom 179 (43%) were colonized with PA. Among the 77 patients who developed PA infection, 69 (90%) had prior PA colonization, and 60 (87%) of these showed genotyping concordance between rectal and clinical isolates. The probability of PA infection 14 days after ICU admission was 26% for carriers versus 5% for noncarriers (P < 0.001). Cox regression analysis identified prior PA rectal colonization as the main predictor of PA infection (hazard ratio [HR], 15.23; 95% confidence interval [CI], 6.9 to 33.7; P < 0.001). Prior use of nonantipseudomonal penicillins was also identified as an independent variable associated with PA infection (HR, 2.15; 95% CI, 1.3 to 3.55; P < 0.003). Our study demonstrated that prior PA rectal colonization is a key factor for developing PA infection.
Insights
Pseudomonas aeruginosa (PA) intestinal colonization significantly predicts subsequent PA infections in intensive care unit (ICU) patients. Prior PA rectal colonization is the primary risk factor for developing PA infection, highlighting the importance of surveillance.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Intestinal colonization by Pseudomonas aeruginosa (PA) is a potential precursor to PA infections, particularly in intensive care unit (ICU) settings.
- The predictive role of PA intestinal colonization and associated risk factors for subsequent infections remain underexplored.
Purpose of the Study:
- To evaluate PA intestinal colonization as a predictor of subsequent PA infections in ICU patients.
- To identify risk factors contributing to the development of PA infection in this vulnerable population.
Main Methods:
- Prospective study involving active surveillance of PA rectal colonization at ICU admission and weekly thereafter.
- Monitoring for PA clinical infections and performing genotypic analysis (pulsed-field gel electrophoresis) of isolates.
- Statistical analysis including Cox regression to determine predictors of PA infection.
Main Results:
- Out of 414 patients, 179 (43%) were colonized with PA. Of 77 patients who developed PA infection, 90% had prior PA colonization, with 87% showing genotypic concordance.
- The probability of PA infection within 14 days was 26% for carriers versus 5% for noncarriers (P < 0.001).
- Prior PA rectal colonization was the main predictor (HR, 15.23; P < 0.001), and prior use of nonantipseudomonal penicillins was an independent risk factor (HR, 2.15; P < 0.003).
Conclusions:
- Prior PA rectal colonization is a critical determinant for the development of PA infection in ICU patients.
- Active surveillance for PA colonization may aid in predicting and potentially preventing subsequent infections.
- Nonantipseudomonal penicillin use is an associated risk factor, warranting further investigation into antibiotic stewardship.
