Colonization pressure as a risk factor of ICU-acquired multidrug resistant bacteria: a prospective observational
J Masse1,2, A Elkalioubie1, C Blazejewski3
1Critical Care Center, CHU Lille, F-59000, Lille, France.
Abstract:
The primary objective of this study was to evaluate the impact of colonization pressure on intensive care unit (ICU)-acquired multidrug resistant bacteria (MDRB). All patients hospitalized for more than 48 h in the ICU were included in this prospective observational study. MDRB were defined as methicillin resistant Staphylococcus aureus, Pseudomonas aeruginosa resistant to ceftazidime or imipenem, Gram-negative bacilli producing extended-spectrum beta-lactamases (ESBL), and all strains of Acinetobacter baumannii and Stenotrophomonas maltophilia. Colonization pressure was daily calculated in the three participating ICUs. Univariate and multivariate analyses were used to determine risk factors for ICU-acquired MDRB. Two hundreds and four (34%) of the 593 included patients acquired an MDRB during their ICU stay. Multivariate analysis identified colonization pressure as an independent risk factor for ICU-acquired MDRB (OR (95% CI) 4.18 (1.03-17.01), p = 0.046). Other independent risk factors for ICU-acquired MDRB were mechanical ventilation (3.08 (1.28-7.38), p = 0.012), and arterial catheter use (OR, 3.04 (1.38-6.68), p = 0.006). ICU-acquired MDRB were associated with increased mortality, duration of mechanical ventilation, and ICU stay. However, ICU-acquired MDRB was not independently associated with ICU-mortality. Colonization pressure is an independent risk factor for acquiring MDRB in the ICU.
Insights
Colonization pressure in intensive care units (ICUs) is a significant risk factor for acquiring multidrug-resistant bacteria (MDRB). Reducing colonization pressure can help prevent MDRB infections in ICUs.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Intensive care units (ICUs) are prone to the spread of multidrug-resistant bacteria (MDRB).
- Understanding risk factors for ICU-acquired MDRB is crucial for infection control.
- Colonization pressure is a proposed driver of MDRB transmission.
Purpose of the Study:
- To evaluate the impact of colonization pressure on the acquisition of MDRB in the ICU.
- To identify independent risk factors for ICU-acquired MDRB.
Main Methods:
- Prospective observational study including 593 patients hospitalized >48 hours in three ICUs.
- Daily calculation of colonization pressure.
- Univariate and multivariate analyses to determine risk factors for ICU-acquired MDRB.
Main Results:
- 34% of patients acquired MDRB during their ICU stay.
- Colonization pressure was an independent risk factor for ICU-acquired MDRB (OR 4.18).
- Mechanical ventilation and arterial catheter use were also independent risk factors.
Conclusions:
- Colonization pressure is a significant, independent risk factor for acquiring MDRB in the ICU.
- ICU-acquired MDRB is associated with longer ICU stays and mechanical ventilation duration.
- While associated with increased mortality, ICU-acquired MDRB was not independently linked to ICU mortality.
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