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Published on: August 30, 2018
Extensively drug-resistant and multidrug-resistant gram-negative pathogens in the neurocritical intensive care unit
Marina Munari1, Francesca Franzoi1, Massimo Sergi1
1UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, via Giustiniani 2, 35128, Padua, Italy.
Background:
Abrupt increase of multidrug-resistant, extensively drug-resistant, and pandrug-resistant bacteria may complicate the course, management, and costs of neurocritical patients and is associated with high morbidity and mortality rates. No data exists regarding risk factors for colonization by gram-negative pathogens in neurocritical patients. The aim of the study was to identify risk factors associated with colonization by multidrug-resistant, extensively drug-resistant, and pandrug-resistant gram-negative bacteria in neurocritical patients.
Methods:
We conducted a retrospective cohort study in a neurointensive care unit over a period of 3 years. We included adult neurocritical patients admitted for more than 48 h. We analyzed several factors including both anamnestic factors and admission diagnosis.
Results:
Four hundred twenty neurocritical patients were retrospectively enrolled. Seventy-three patients developed colonization by multidrug-resistant and 53 by extensively drug-resistant gram negative pathogens. Logistic regression identified intensive care unit length of stay (LOS) as the strongest predictor for both multidrug-resistant (AUC 0.877; 95% CI 0.841-0.913) and extensively drug-resistant (AUC 0.839 0.787-0.892) gram negative pathogens. In addition, external ventricular drainage and intracerebral pressure monitoring catheter were risk factors for XDR. Survival analysis revealed that MDR bacteria colonization happens earlier (log-rank test p = 0.017).
Conclusions:
Optimization of healthcare strategies is required in order to reduce patients' length of stay to prevent multi- and extensively-drug gram-negative colonizations. Indeed, an early external ventricular drainage and intracerebral pressure monitoring catheter removal is deemed necessary as soon as clinically appropriate.
Insights
Longer intensive care unit stays increase the risk of multidrug-resistant (MDR) and extensively drug-resistant (XDR) gram-negative bacteria colonization in neurocritical patients. Early removal of monitoring devices is recommended.
Area of Science:
- Neurocritical care
- Infectious diseases
- Antimicrobial resistance
Background:
- Rising rates of multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) bacteria pose significant challenges in neurocritical care.
- High morbidity and mortality rates are associated with these resistant pathogens.
- Limited data exists on risk factors for gram-negative pathogen colonization in neurocritical patients.
Purpose of the Study:
- To identify risk factors for colonization by MDR, XDR, and PDR gram-negative bacteria in neurocritical patients.
- To inform strategies for preventing and managing resistant bacterial infections in this vulnerable population.
Main Methods:
- Retrospective cohort study conducted in a neurointensive care unit over three years.
- Inclusion criteria: adult neurocritical patients admitted for over 48 hours.
- Analysis of anamnestic factors and admission diagnoses.
Main Results:
- Four hundred twenty patients were enrolled; 73 developed MDR and 53 developed XDR gram-negative pathogen colonization.
- Intensive care unit length of stay (LOS) was the strongest predictor for both MDR and XDR colonization.
- External ventricular drainage and intracranial pressure monitoring catheters were identified as risk factors for XDR colonization.
- MDR bacteria colonization occurred earlier than XDR colonization.
Conclusions:
- Healthcare strategies should focus on reducing patients' length of stay to prevent MDR and XDR gram-negative colonization.
- Early removal of external ventricular drainage and intracranial pressure monitoring catheters, when clinically appropriate, is recommended to mitigate risks.
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