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Clinical Impact of Colonization with Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Admitted
Giancarlo Ceccarelli1,2,3, Francesco Alessandri2,4, Sonia Moretti5
1Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Roma, Italy.
Abstract:
Multidrug-resistant (MDR) Gram-negative bacteria (GNB) have raised concerns as common, frequent etiologic agents of nosocomial infections, and patients admitted to intensive care units (ICUs) present the highest risk for colonization and infection. The incidence of colonization and infection in trauma patients remains poorly investigated. The aim of this study was to assess the risk factors for Carbapenem-resistant (CR)-GNB colonization and the clinical impact of colonization acquisition in patients with severe trauma admitted to the ICU in a CR-GNB hyperendemic country. This is a retrospective observational study; clinical and laboratory data were extracted from the nosocomial infection surveillance system database. Among 54 severe trauma patients enrolled in the study, 28 patients were colonized by CR-GNB; 7 (12.96%) patients were already colonized at ICU admission; and 21 (38.89%) patients developed a new colonization during their ICU stay. Risk factors for colonization were the length of stay in the ICU (not colonized, 14.81 days ± 9.1 vs. colonized, 38.19 days ± 27.9; p-value = 0.001) and days of mechanical ventilation (not colonized, 8.46 days ± 7.67 vs. colonized, 22.19 days ± 15.09; p-value < 0.001). There was a strong statistical association between previous colonization and subsequent development of infection (OR = 80.6, 95% CI 4.5−1458.6, p-value < 0.001). Factors associated with the risk of infection in colonized patients also included a higher Charlson comorbidity index, a longer length of stay in the ICU, a longer duration of mechanical ventilation, and a longer duration of treatment with carbapenem and vasopressors (not infected vs. infected: 0(0−4) vs. 1(0−3), p = 0.012; 24.82 ± 16.77 vs. 47 ± 28.51, p = 0.016; 13.54 ± 15.84 vs. 31.7 ± 16.22, p = 0.008; 1.09 ± 1.14 vs. 7.82 ± 9.15, p = 0.008). The adoption of MDR-GNB colonization prevention strategies in critically ill patients with severe trauma is required to improve the quality of care and reduce nosocomial infections, length of hospital stay and mortality.
Insights
Multidrug-resistant Gram-negative bacteria colonization is common in severe trauma ICU patients. Longer ICU stays and mechanical ventilation increase colonization risk, which strongly predicts infection.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Multidrug-resistant Gram-negative bacteria (MDR-GNB) are significant causes of nosocomial infections, particularly in intensive care units (ICUs).
- Trauma patients in ICUs face a high risk of colonization and infection by MDR-GNB, yet this remains understudied.
- Carbapenem-resistant Gram-negative bacteria (CR-GNB) pose a growing threat in hyperendemic regions.
Purpose of the Study:
- To identify risk factors for CR-GNB colonization in severe trauma patients admitted to the ICU.
- To evaluate the clinical impact of CR-GNB colonization acquisition in this patient population.
- To inform prevention strategies for MDR-GNB in critically ill trauma patients.
Main Methods:
- Retrospective observational study utilizing data from a nosocomial infection surveillance system.
- Analysis of clinical and laboratory data from 54 severe trauma patients admitted to the ICU.
- Statistical analysis to determine risk factors for colonization and infection.
Main Results:
- 28 out of 54 patients (51.85%) were colonized by CR-GNB; 7 (12.96%) on admission, 21 (38.89%) acquired during ICU stay.
- Significant risk factors for colonization included longer ICU length of stay (p=0.001) and mechanical ventilation duration (p<0.001).
- Previous CR-GNB colonization was a strong predictor of subsequent infection (OR=80.6, p<0.001).
Conclusions:
- Extended ICU stays and mechanical ventilation are key risk factors for CR-GNB colonization in severe trauma patients.
- Colonization significantly increases the risk of developing CR-GNB infections in this vulnerable group.
- Implementing MDR-GNB colonization prevention strategies is crucial for improving care quality and reducing adverse outcomes.
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