Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit

Area of Science:

• Infectious Diseases
• Microbiology
• Public Health

Background:

• Multidrug-resistant Gram-negative bacteria (MDR-GNB) pose a significant public health threat due to acquired resistance to broad-spectrum antibacterials.
• Carriage of MDR-GNB by patients is a key transmission route in healthcare settings, yet risk factors remain underexplored.
• Limited data necessitates identifying predictors of MDR-GNB carriage to inform screening and control strategies.

Purpose of the Study:

• To identify risk factors associated with MDR-GNB carriage upon admission to an intensive care unit (ICU).
• To provide data that can optimize screening protocols for MDR-GNB in high-risk patient populations.

Main Methods:

• A case-control study was conducted involving adult ICU admissions over one year.
• Sociodemographic, clinical, and microbiological data were collected.
• Multivariate logistic regression analysis was employed to determine significant risk factors.

Main Results:

• Of 1476 ICU admissions, 91 (6.2%) patients carried MDR-GNB.
• Key risk factors identified included liver cirrhosis (OR 6.54), previous MDR-GNB carriage (OR 5.34), digestive surgery (OR 2.83), and increased length of hospital stay (OR 1.01 per day).
• Escherichia coli and Klebsiella pneumoniae were the most prevalent MDR-GNB, with extended-spectrum beta-lactamase production being the most common resistance mechanism.

Conclusions:

• Liver cirrhosis emerged as the primary comorbidity associated with MDR-GNB carriage upon ICU admission.
• These findings highlight specific patient groups at higher risk, enabling targeted screening and intervention efforts.
• Understanding these risk factors is essential for developing effective strategies to combat MDR-GNB transmission in critical care environments.