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Published on: August 30, 2018
Tracking Epidemiological Characteristics and Risk Factors of Multi-Drug Resistant Bacteria in Intensive Care Units
Cuiyun Wu1, Jiehong Lu1, Lijin Ruan2
1Department of Clinical Laboratory, Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, Guangdong, People's Republic of China.
Objectives:
Multi-drug resistance (MDR) emerged as a serious threat in intensive care unit (ICU) settings. Our study aimed to investigate the major pathogens in ICU and identify the risk factors for MDR infection.
Methods:
We performed a retrospective analysis of patients admitted to the ICU. Multivariate logistic regression was applied to identify the independent predictors, and then a nomogram to predict the probability of MDR infection.
Results:
A total of 278 patients with 483 positive cultures were included. 249 (51.55%) had at least one MDR pathogen, including extensively drug-resistant (XDR) 77 (30.92%) and pan drug-resistant (PDR) 39 (15.66%), respectively. Klebsiella pneumonia was the most frequently isolated pathogen. We identified the number of bacteria (OR 2.91, 95% CI 1.97-4.29, P < 0.001), multiple invasive procedures (OR 2.23, 95% CI 1.37-3.63, P = 0.001), length of stay (LOS) (OR 1.01, 95% CI 1.00-1.02, P = 0.007), Hemoglobin (Hb) (OR 0.99, 95% CI 0.98-1.00, P = 0.01) were independent risk factors for MDR infection. Our nomogram displayed good discrimination with curve AUC was 0.75 (95% CI: 0.70-0.81). The decision curves also indicate the clinical utility of our nomogram. Additionally, the in-hospital mortality with MDR pathogens was independently associated with XDR (HR, 2.60; 95% CI: 1.08-6.25; P = 0.03) and total protein (TP) (HR, 0.95; 95% CI: 0.91-0.99; P = 0.03).
Conclusion:
The number of bacteria, multiple invasive procedures, LOS, and Hb were the independent predictors associated with MDR pathogens. Our nomogram is potentially useful for predicting the occurrence of MDR infection. Besides, we also identify XDR and TP as the independent risk factors for in-hospital mortality with MDR infection. The current prevalence of MDR strains was also described. The results will contribute to the identification and preventive management of patients at increased risk of infection.
Insights
Multi-drug resistance (MDR) is a significant threat in ICUs. Key risk factors for MDR infections include bacterial load, invasive procedures, and length of stay, with a developed nomogram aiding prediction.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Multi-drug resistance (MDR) poses a critical challenge in intensive care unit (ICU) settings.
- Identifying major pathogens and their associated risk factors is crucial for effective management.
- Understanding predictors of MDR infection can guide preventive strategies and improve patient outcomes.
Purpose of the Study:
- To investigate the predominant pathogens responsible for infections in the ICU.
- To identify independent risk factors associated with the development of MDR infections.
- To develop and validate a predictive model (nomogram) for MDR infection probability.
Main Methods:
- Retrospective analysis of patients admitted to the ICU.
- Multivariate logistic regression to determine independent predictors of MDR infection.
- Development and validation of a nomogram for predicting MDR infection risk, assessing its discrimination (AUC) and clinical utility.
Main Results:
- A high prevalence of MDR pathogens (51.55%) was observed, including extensively drug-resistant (XDR) and pan drug-resistant (PDR) strains.
- Key independent risk factors for MDR infection included bacterial load, multiple invasive procedures, length of stay (LOS), and hemoglobin (Hb) levels.
- The developed nomogram demonstrated good predictive performance (AUC = 0.75), indicating clinical utility. XDR and total protein (TP) were linked to in-hospital mortality.
Conclusions:
- Bacterial load, invasive procedures, LOS, and Hb are significant predictors of MDR infection in the ICU.
- The developed nomogram shows promise for predicting MDR infection occurrence, aiding early intervention.
- XDR and TP levels are identified as independent risk factors for in-hospital mortality in MDR-infected patients, highlighting areas for targeted management.
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