[Analysis of the predictive value of preventive isolation criteria in the intensive care unit]
A Abella Álvarez1, D Janeiro Lumbreras2, B Lobo Valbuena1
1Servicio de Medicina Intensiva, Hospital Universitario del Henares, Madrid, España; Grupo de Investigación en Patología Crítica de la Universidad Francisco de Vitoria, Madrid, España.
Objective:
To assess the diagnostic accuracy of the criteria used to detect patients carrying multiresistant microorganisms (MRMs).
Design:
A prospective observational study was carried out from May 2014 to May 2015.
Setting:
Polyvalent Intensive Care Unit.
Patients:
A cohort of consecutively admitted patients meeting the following criteria for preventive isolation according to the "Zero Resistance" project: hospital length of stay>4 days in the last three months ("hospital"); antibiotherapy during one week in the last month ("antibiotic"); institutionalized patients or recurrent contact with healthcare ("institution or care"); MRM carrier in the last 6 months ("previous MRM").
Variables:
Demographic data, culture results and isolation time. A multivariate analysis was performed using multiple logistic regression between each of the risk factors and patient MRM carrier status.
Results:
During the study period, 575 patients were admitted, of which 28% met the isolation criteria (162). Fifty-one (31%) were MRM carriers. Of the patients who did not meet the criteria, 29 (7%) were carriers. In the multivariate analysis, the only variable independently associated to carrier status was "previous MRM", with OR=12.14 (95%CI 4.24-34.77).
Conclusions:
The only criterion independently associated with the ability to detect patients with MRMs upon admission to the ICU was the existence of "previous MRM".
Insights
Previous multiresistant microorganism (MRM) carrier status is the most accurate predictor for detecting MRM patients upon ICU admission. This finding aids in targeted infection control strategies for intensive care units.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Multiresistant microorganisms (MRMs) pose a significant threat in healthcare settings, particularly in intensive care units (ICUs).
- Accurate and timely detection of MRM carriers is crucial for implementing effective infection control measures and preventing transmission.
Purpose of the Study:
- To evaluate the diagnostic accuracy of various criteria used to identify patients carrying MRMs upon admission to an ICU.
- To determine which risk factors are independently associated with MRM carrier status in critically ill patients.
Main Methods:
- A prospective observational study was conducted in a Polyvalent Intensive Care Unit from May 2014 to May 2015.
- Patients meeting specific isolation criteria (e.g., recent hospitalization, antibiotic use, institutionalization, or previous MRM status) were assessed.
- Multivariate logistic regression analysis was used to identify independent predictors of MRM carrier status.
Main Results:
- Out of 575 admitted patients, 162 (28%) met the isolation criteria, and 51 (31%) of these were MRM carriers.
- Among patients not meeting the criteria, 7% were MRM carriers.
- Previous MRM carrier status was the only variable independently associated with current MRM carrier status (OR=12.14).
Conclusions:
- The presence of previous MRM colonization is the strongest independent predictor for identifying MRM carriers upon ICU admission.
- Relying solely on historical MRM status can significantly improve the detection accuracy in high-risk patient populations.
- This highlights the importance of screening for prior MRM infections in patient history for effective infection control.
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