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Published on: August 30, 2018
Risk factors for bloodstream infection by multidrug-resistant organisms in critically ill patients in a reference
Luciana Rodrigues Pires de Campos1, Marina Farrel Côrtes2, Beatriz Deo2
1Hospital Municipal José Carvalho de Florence, São José dos Campos, Brazil.
Background:
Bloodstream infections (BSI) by multidrug-resistant (MDR) organisms are responsible for significant mortality in critically ill trauma patients. Our objective is to identify the risk factors for BSI by MDR agents and their resistance mechanisms in a trauma reference hospital.
Methods:
During 18 months, all patients admitted in our Intensive Care Unit (ICU) were enrolled in this prospective cohort. We included the first episode of BSI by carbapenem-resistant Gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus. Demographic and clinical data were compared among patients with and without BSI and variables with P < .05 were tested in a multivariate analysis. We performed PCR for identification of carbapenemase and SCC mec genes and Pulsed-field gel electrophoresis for clonality.
Results:
Out of 1,528 patients, 302 (19.8%) were trauma and 66 (4.3%) had a MDR-BSI (19.5% were trauma). The multivariate analysis showed that mechanical ventilation (OR3.16; 95% CI 1-8; P = .02), hemodialysis (OR3.16; 95% CI 1-5; P = .0003) and surgery (OR1.76; 95% CI 1-3; P = .04) were independent risk factors for MDR-BSI. The most frequent MDR were Klebsiella pneumoniae (n = 26) and MRSA (n = 27). Regarding K pneumoniae strains (n = 24), 20 (83.8%) harbored bla KPC gene and 1 bla NDM. The majority of KPC isolates belonged to a predominant clone; while the MRSA were polyclonal and SCC mec type II.
Conclusions:
Mechanical ventilation, surgery and hemodialysis were independent risk factors for MDR-BSI in our cohort, but trauma was not. KPC was the main mechanism of resistance among carbapenem-resistant K pneumoniae that belonged to a predominant clone which could indicate cross-transmission.
Insights
Multidrug-resistant bloodstream infections (MDR-BSI) are a significant threat. Mechanical ventilation, surgery, and hemodialysis are key risk factors, not trauma itself, with KPC resistance common in Klebsiella pneumoniae.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Bloodstream infections (BSI) caused by multidrug-resistant (MDR) organisms pose a significant mortality risk in critically ill trauma patients.
- Identifying risk factors and resistance mechanisms for MDR-BSI is crucial for effective management in trauma settings.
Purpose of the Study:
- To identify independent risk factors associated with MDR-BSI in critically ill trauma patients.
- To characterize the resistance mechanisms and clonal spread of common MDR organisms causing BSI.
Main Methods:
- A prospective cohort study was conducted over 18 months in an Intensive Care Unit (ICU).
- Patients with the first episode of BSI caused by carbapenem-resistant Gram-negative bacteria, MRSA, or VRE were included.
- Demographic and clinical data were analyzed using multivariate analysis; PCR and PFGE were used for resistance gene and clonality identification.
Main Results:
- Out of 1,528 patients, 66 (4.3%) had MDR-BSI, with 19.5% of these being trauma patients.
- Independent risk factors for MDR-BSI included mechanical ventilation (OR 3.16), hemodialysis (OR 3.16), and surgery (OR 1.76).
- Klebsiella pneumoniae (bla KPC gene) and MRSA were the most frequent MDR pathogens; KPC-producing K. pneumoniae strains showed a predominant clonal pattern.
Conclusions:
- Mechanical ventilation, surgery, and hemodialysis are significant independent risk factors for MDR-BSI, while trauma itself was not identified as a risk factor in this cohort.
- The bla KPC gene was the primary resistance mechanism in carbapenem-resistant K. pneumoniae, with evidence of a predominant clone suggesting potential cross-transmission.
- MRSA isolates were polyclonal, indicating different sources or strains.
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