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Published on: August 30, 2018
Risk factors for multidrug-resistant bacteria in critically ill children and MDR score development
Cristina González-Anleo1,2, Mònica Girona-Alarcón3,4,5, Alba Casaldàliga1
1Pharmacy Department, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Insights
A new MDR score helps identify patients at high risk for multidrug-resistant infections in the pediatric intensive care unit (PICU). This tool aids in guiding empirical antibiotic therapy for better patient outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Antimicrobial resistance (AMR) and healthcare-associated infections (HAIs) are critical issues in pediatric intensive care units (PICUs).
- Device-associated HAIs (DA-HAIs) caused by multidrug-resistant (MDR) bacteria pose significant risks, potentially leading to inappropriate empirical antibiotic therapy, adverse outcomes, and increased mortality.
- Prompt identification of patients at high risk for MDR infections is crucial for effective management.
Purpose of the Study:
- To develop and validate a risk score for the early identification of patients at high risk of developing multidrug-resistant (MDR) healthcare-associated infections (HAIs) in the pediatric intensive care unit (PICU).
- To assess the utility of the MDR score in stratifying patients and guiding empirical antibiotic therapy decisions.
Main Methods:
- A single-center, prospective, observational study was conducted from January 2015 to December 2022.
- Included were PICU patients with microbiologically confirmed DA-HAIs.
- Demographic, clinical characteristics, and outcomes were compared between MDR and non-MDR DA-HAI groups. A risk score was developed based on independent risk factors identified through univariate and multivariate analyses.
Main Results:
- Out of 257 DA-HAI cases, 86 (33.46%) were caused by MDR microbes.
- Independent risk factors for MDR-DA-HAI identified were previous comorbidity (OR 2.201), previous MDR colonization (OR 5.149), and PICU length of stay >9 days (OR 1.782).
- The developed MDR score demonstrated a global sensitivity of 82.6% for MDR-DA-HAI, with 91.8% specificity in the high-risk group. 81.0% of low-risk patients had non-MDR infections.
Conclusions:
- The MDR score is a valuable tool for stratifying patients into risk groups for MDR-DA-HAIs in the PICU.
- The score can assist in optimizing empirical antibiotic therapy, potentially reducing delays in appropriate treatment and improving patient outcomes.
- Individual patient risk stratification is essential for managing MDR infections effectively.
Abstract:
Antimicrobial resistance and healthcare-associated infections (HAIs) are major health concerns in the pediatric intensive care unit (PICU). Device-associated HAIs (DA-HAIs) produced by multidrug-resistant (MDR) bacteria are especially worrying, as they can lead to an inappropriate empirical antibiotic therapy, worsened outcomes and increased mortality. The MDR score was designed to enable the prompt identification of patients at high risk of developing an MDR infection. This was a single-center, prospective, observational study, conducted between January 2015 and December 2022, including PICU patients with a microbiologically confirmed DA-HAI. Demographic, clinical characteristics and outcomes were compared between patients with a DA-HAI caused by MDR and non-MDR-associated DA-HAI, and a risk score for multi-resistance was designed. In total, 257 DA-HAI cases were included, 86 (33.46%) caused by an MDR microbe. In the univariate analysis, comorbidity (p = 0.002), previous MDR colonization (p < 0.001), previous surgery (p = 0.018), and previous antibiotic therapy (p = 0.009) were more frequent among MDR-associated DA-HAI (MDR DA-HAI). In addition, days from device insertion to infection and from PICU admission (p < 0.005) to infection were longer in patients with MDR. In the multivariate analysis, previous comorbidity (OR 2.201), previous MDR colonization (OR 5.149), and PICU length of stay longer than 9 days (OR 1.782) were independently associated with MDR-DA-HAI. Using these three independent risk factors for MDR, a risk score was created: the MDR score. Three risk groups were obtained: low risk (0-2 points), intermediate risk (3-7 points), and high risk (8-12 points). Seventy-one patients with MDR-DA-HAI (82.6%) were classified in the intermediate or high-risk group, with a global sensitivity of 82.6%. The specificity in the high-risk group was 91.8%, and 81.0% of patients who were stratified into the low-risk group had non-MDR-associated infections, so they were correctly classified. Conclusions: The MDR score can be a useful tool to stratify patients in risk groups for MDR-DA-HAI. It may help to guide the choice of empirical therapy, leading to early optimization and avoiding delays in establishing appropriate treatment. This study reinforces the importance of stratifying patients based on their individual risk profile for MDR infection.
