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Risk factors for colonisation by Multidrug-Resistant bacteria in critical care units
Yolanda Garcia-Parejo1, Jesus Gonzalez-Rubio2, Jesus Garcia Guerrero1
1Department of Preventive Medicine and Public Health, Albacete University Teaching Hospital Complex, 02006 Albacete, Spain.
Introduction:
Antimicrobial resistance is a major public health challenge recognised by the WHO as an urgent global healthcare concern. Patients in Intensive Care Units (ICUs) are particularly prone to colonisation and/or infection by multidrug-resistant organisms (MDROs).
Objectives:
Delineate the epidemiological characteristics and risk factors for MDROs colonisation in mixed ICUs and Resuscitation Units by focusing on initial and nosocomial colonisation.
Material And Methods:
A descriptive observational study with analytical elements. It uses the Zero-Resistance register from the Preventive Medicine Service of the Albacete General University Hospital (Spain) from April 2016 to December 2021. It identifies the risk factors for MDROs colonisation.
Results:
Of 7,541 cases, 61.0 % with initial colonisation had risk factors for MDROs versus 34.0 % not colonised upon hospitalisation (p < 0.001). Significant risk factors for initial colonisation included hospitalisation for ≥ 5 days within the last 3 months, prior MDROs colonisation/infection and institutionalization. No significant risk factor differences were found for nosocomial colonisation. An association between longer ICU stays and nosocomial colonisation (p < 0.001) was noted.
Conclusions:
Significant risk factors for initial MDROs colonisation were hospitalisation for ≥ 5 days in the last 3 months, prior MDROs colonisation/infection and institutionalisation. Longer ICU stays increased the nosocomial colonisation risk.
Implications For Clinical Practice:
This study underscores the importance to early identify and manage patients at risk for MDROs colonisation in ICUs. By recognising factors (i.e. previous hospitalisations, existing colonisation or infection, impact of prolonged ICU stay), healthcare providers can implement targeted strategies to mitigate the spread of MDROs; e.g. enhanced surveillance, stringent infection control measures and judicious antibiotics use. Our findings highlight the need for a comprehensive approach to manage antimicrobial resistance in critical care settings to ultimately improve patient outcomes and reduce MDROs burden in hospitals.
Insights
Identifying patients with multidrug-resistant organisms (MDROs) colonisation in Intensive Care Units (ICUs) is crucial. Previous hospitalisation and longer ICU stays are key risk factors for initial and nosocomial MDROs colonisation, respectively.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- Antimicrobial resistance (AMR) is a global health threat.
- Intensive Care Units (ICUs) are high-risk environments for multidrug-resistant organisms (MDROs) colonisation and infection.
Purpose of the Study:
- To determine epidemiological characteristics and risk factors for MDROs colonisation in mixed ICUs.
- To differentiate risk factors for initial versus nosocomial MDROs colonisation.
Main Methods:
- A descriptive observational study with analytical elements.
- Utilised the Zero-Resistance register from Albacete General University Hospital (April 2016 - December 2021).
- Identified risk factors associated with MDROs colonisation.
Main Results:
- 61.0% of patients with initial colonisation had risk factors, compared to 34.0% without (p < 0.001).
- Significant risk factors for initial colonisation included prior hospitalisation (≥5 days/3 months), previous MDROs colonisation/infection, and institutionalisation.
- Longer ICU stays were associated with increased nosocomial colonisation (p < 0.001).
Conclusions:
- Hospitalisation history, prior MDROs status, and institutionalisation are significant risk factors for initial colonisation.
- Prolonged ICU stays elevate the risk of nosocomial MDROs colonisation.
- Early identification and management of at-risk patients are essential for controlling MDROs spread in ICUs.
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