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Multidrug-Resistant Bacteria on Critically Ill Patients with Sepsis at Hospital Admission: Risk Factors and Effects
Marcelo de Oliveira Maia1,2, Carlos Darwin Gomes da Silveira1,3,4, Maura Gomes5
1Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil.
Purpose:
To evaluate the effect of MDRO infection on hospital mortality and the risk factors among critically ill patients with sepsis at hospital admission.
Patients And Methods:
A cross-sectional study was performed between April 2019 and May 2020, followed by a cohort to evaluate hospital mortality that prospectively included all consecutive patients 18 years or older with sepsis admitted within 48 hours of hospital admission to an adult ICU in Brazil. Patients' characteristics, blood samples within one hour of ICU admission, and microbiological results within 48h of hospital admission were collected. In addition, descriptive statistics, binary logistic regression, and propensity score matching were performed.
Results:
At least one MDRO was isolated in 85 patients (9.8%). The extended-spectrum beta-lactamase-producing Enterobacterales are the most frequent organism (56.1%). Hypoxemic acute respiratory failure (OR 1.87, 95% CI 1.02-3.40, p = 0.04), Glasgow Coma Score below 15 (OR 2.57, 95% CI 1.38-4.80, p < 0.01), neoplasm (OR 2.66, 95% CI 1.04-6.82, p = 0.04) and hemoglobin below 10.0 g/dL (OR 1.82, 95% CI 1.05-3.16, p = 0.03) were associated with increased MDRO. Admission from the Emergency Department (OR 0.25, 95% CI 0.14-0.43, p < 0.01) was associated with decreased MDRO. In the multivariate analysis, MDRO at hospital admission increased hospital mortality (OR 2.80, 95% CI 1.05-7.42, p = 0.04). After propensity score-matching adjusted to age, APACHE II, SOFA, and dementia, MDRO at hospital admission was associated with significantly high hospital mortality (OR 2.80, 95% CI 1.05-7.42, p = 0.04). The E-value of adjusted OR for the effect of MDRO infection on hospital mortality was 3.41, with a 95% CI of 1.31, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect.
Conclusion:
MDRO infection increased hospital mortality, and MDRO risk factors should be accessed even in patients admitted to ICU within 48 hours of hospital admission.
Insights
Multi-drug resistant organism (MDRO) infections significantly increase hospital mortality in critically ill sepsis patients. Early identification of MDRO risk factors is crucial, even for patients admitted within 48 hours to the ICU.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Multi-drug resistant organisms (MDROs) pose a significant threat in intensive care units (ICUs).
- Understanding the impact of MDRO infections on mortality in sepsis patients is critical for improving patient outcomes.
Purpose of the Study:
- To evaluate the effect of multi-drug resistant organism (MDRO) infection on hospital mortality.
- To identify risk factors associated with MDRO infection among critically ill sepsis patients at hospital admission.
Main Methods:
- A prospective cohort study including adult sepsis patients admitted to an ICU in Brazil.
- Data collection included patient characteristics, blood samples, and microbiological results.
- Statistical analyses involved descriptive statistics, logistic regression, and propensity score matching.
Main Results:
- MDROs were isolated in 9.8% of patients, with extended-spectrum beta-lactamase-producing Enterobacterales being most frequent.
- Risk factors for MDRO infection included hypoxemic respiratory failure, low Glasgow Coma Score, neoplasm, and low hemoglobin.
- MDRO infection at hospital admission was significantly associated with increased hospital mortality (OR 2.80).
Conclusions:
- Multi-drug resistant organism (MDRO) infection is an independent risk factor for increased hospital mortality in critically ill sepsis patients.
- Risk factors for MDRO should be assessed early, even in patients admitted to the ICU within 48 hours of hospital admission.
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