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The health facility as a risk factor for multidrug-resistant gram-negative bacteria in critically ill patients with
Viviane de Macedo1, Gabriela de Souza Dos Santos2, Rodolff Nunes da Silva3
1Hospital Infection Control and Epidemiology Center, Santa Casa de Curitiba, Curitiba, PR, Brazil; Faculdade de Medicina, Universidade Positivo, Curitiba, PR, Brazil; Department of Infectious Diseases, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Background:
The relationship between Multidrug Resistant-Gram Negative Bacteria (MDR-GNB) infection and colonization in critically ill COVID-19 patients has been observed, however, it is still poorly understood. This study evaluated the risk factors for acquiring MDR-GNB in patients with severe COVID-19 in Intensive Care Units (ICU).
Methods:
This is a nested case-control study in a cohort of 400 adult patients (≥ 18 years old) with COVID-19, hospitalized in the ICU of 4 hospitals in the city of Curitiba, Brazil. Cases were critical COVID-19 patients with one or more MDR GNB from any surveillance and/or clinical cultures were taken during their ICU stay. Controls were patients from the same units with negative cultures for MDR-GNB. Bivariate and multivariate analyses were done.
Results:
Sixty-seven cases and 143 controls were included. Independent risk factors for MDR bacteria were: male gender (OR = 2.6; 95% CI 1.28‒5.33; p = 0.008); the hospital of admission (OR = 3.24; 95% CI 1.39‒7.57; p = 0.006); mechanical ventilation (OR = 25.7; 95% CI 7.26‒91; p < 0.0001); and desaturation on admission (OR = 2.6; 95% CI 1.27‒5.74; p = 0.009).
Conclusions:
Male gender, desaturation, mechanical ventilation, and the hospital of admission were the independent factors associated with MDR-GNB in patients in the ICU with COVID-19. The only modifiable factor was the hospital of admission, where a newly opened hospital posed a higher risk. Therefore, coordinated actions toward a better quality of care for critically ill COVID-19 patients are essential.
Insights
Male gender, desaturation, mechanical ventilation, and hospital of admission are key risk factors for Multidrug-Resistant Gram-Negative Bacteria (MDR-GNB) in critically ill COVID-19 patients. A newly opened hospital increased risk, highlighting the need for improved care quality.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- The relationship between Multidrug-Resistant Gram-Negative Bacteria (MDR-GNB) infection and colonization in critically ill COVID-19 patients is not well understood.
- This study aimed to identify risk factors for acquiring MDR-GNB in severe COVID-19 patients admitted to Intensive Care Units (ICUs).
Purpose of the Study:
- To evaluate risk factors associated with MDR-GNB acquisition in critically ill COVID-19 patients within ICUs.
- To inform strategies for preventing MDR-GNB infections in this vulnerable patient population.
Main Methods:
- A nested case-control study was conducted with 400 adult COVID-19 patients in ICUs across four hospitals in Curitiba, Brazil.
- Cases were defined as critical COVID-19 patients with MDR-GNB detected in cultures during their ICU stay; controls had negative cultures.
- Bivariate and multivariate analyses were performed to identify independent risk factors.
Main Results:
- Sixty-seven cases and 143 controls were analyzed.
- Independent risk factors for MDR-GNB included male gender (OR=2.6), hospital of admission (OR=3.24), mechanical ventilation (OR=25.7), and desaturation on admission (OR=2.6).
Conclusions:
- Male gender, desaturation, mechanical ventilation, and hospital of admission are significant independent factors associated with MDR-GNB in ICU patients with COVID-19.
- The hospital of admission, particularly a newly opened facility, was a modifiable risk factor, emphasizing the need for coordinated actions to enhance care quality for critically ill COVID-19 patients.
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