Incidence and Risk Factors Associated with Multi-Drug-Resistant Pathogens in a Critically Ill Trauma Population: A
Michaelia Cucci1, Courtney Wooten1, Melissa Fowler1
1Department of Pharmacy, Cleveland Clinic Akron General, Akron, Ohio.
Abstract:
Multi-drug resistance is considered a serious health threat particularly in the intensive care unit (ICU) setting. Studies evaluating multi-drug-resistant (MDR) pathogens in critically ill trauma patients are limited. The objectives were to describe the incidence of MDR, extensive-drug-resistant (XDR), and pan-drug-resistant (PDR) organism growth in ICU patients admitted with traumatic injuries and to identify any risk factors associated with MDR growth. This was a retrospective single-center cohort study of all ICU adult patients identified via the institution's trauma registry from January 1, 2016 to August 31, 2017. Patients were included if they had positive culture growth with susceptibility data taken during the index hospitalization. Patients were excluded if their cultures were drawn within 48 hours of emergency department triage. Study groups were defined based on the presence of at least one MDR pathogen during the index hospitalization. A total of 2,578 charts were reviewed and 95 patients (mean age, 60 years; 66 males [69%]) with 201 total cultures were included. The majority of positive cultures were from respiratory (69%) and urinary (16%) sources. Of the 201 positive cultures, the majority of species identified was Enterobacteriaceae (47%), Staphylococcus (32%), Enterococcus (7%), Acinetobacter (5%), and Pseudomonas (3%). Of the 95 patients with positive cultures, the incidence of MDR, XDR, and PDR organisms was found to be 31%, 17%, and 0%, respectively. Augmented renal clearance (ARC) was the only risk factor associated with an increased risk for MDR organism growth (adjusted odds ratio 9.78, 95% confidence interval [CI] 2.56-37.41; p = 0.001). In this cohort of critically ill trauma patients, the incidence of an MDR pathogen occurred in 31% of patients. This is the first study to find an association of ARC and multi-drug resistance, which should be further validated as a potential cause for MDR organisms.
Insights
Multi-drug resistant (MDR) organisms occurred in 31% of critically ill trauma patients in the ICU. Augmented renal clearance (ARC) was identified as a significant risk factor for MDR growth, warranting further investigation.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Trauma Surgery
Background:
- Multi-drug resistance (MDR) poses a significant threat in intensive care units (ICUs).
- Limited data exists on MDR pathogens in critically ill trauma patients.
- Understanding incidence and risk factors for MDR in this population is crucial.
Purpose of the Study:
- To determine the incidence of MDR, extensive-drug-resistant (XDR), and pan-drug-resistant (PDR) organisms in ICU trauma patients.
- To identify risk factors associated with MDR organism growth in this cohort.
Main Methods:
- Retrospective single-center cohort study.
- Included adult ICU patients with positive cultures and susceptibility data during hospitalization (excluding cultures within 48 hours of triage).
- Defined study groups based on the presence of at least one MDR pathogen.
Main Results:
- 31% of 95 included patients had MDR organisms; 17% had XDR; 0% had PDR.
- Most positive cultures were from respiratory (69%) and urinary (16%) sources.
- Augmented renal clearance (ARC) was the sole identified risk factor for MDR growth (aOR 9.78, p=0.001).
Conclusions:
- MDR pathogens were present in 31% of critically ill trauma patients.
- This study is the first to associate ARC with increased risk of MDR organism growth.
- Further research is needed to validate ARC as a potential cause for MDR organisms.
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