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Published on: January 16, 2019
Colonisation at admission to an intensive care unit in an Italian University Hospital: Risk factors and clinical
Carlo Pallotto1, Giovanni Genga1, Elisabetta Svizzeretto1
1Department of Medicine and Surgery, Infectious Diseases Clinic, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
Background:
Antibiotic resistance represents a great concern worldwide with increasing related morbidity and mortality. Multidrug resistant microorganisms are going to be detected more and more frequently even in the community setting. Therefore, patients could be colonised even at the admission to the hospital.
Objective:
The aim of this study is to evaluate colonisation at admission to an intensive care unit (ICU) and the acquisition of new colonisation during the ICU stay and the related risk factors. Secondly, healthcare-associated infections and surgical prophylaxis efficacy were also evaluated.
Methods:
Retrospective observational study. All the patients admitted to the post-cardiosurgical ICU from 01 January to 30 June 2021 were enrolled. Colonisation was evaluated by rectal and nasal swab at admission or at the pre-hospitalisation visit and then every 7 days during the hospital stay.
Results:
80 out of 183 patients were colonised at admission, 46 by non-susceptible microorganisms (NSM). An antibiotic treatment in the previous 3 months was identified as risk factor for NSM colonisation. According to these isolates, about one third of the surgical prophylaxis could be ineffective. During the hospital stay, 36 patients acquired new colonisations; antibiotic treatment and length of hospital stay were recognised as risk factors. At least one (≥1) healthcare-associated infection (HAI) was detected in 54 patients (68 episodes); HAIs were significantly more frequent in the colonised patients. Moreover, in 35/68 HAIs aetiology was consistent with the colonisation.
Discussion:
Knowing patients' colonisations could be fundamental to tailor antibiotic treatments and prophylaxis and to avoid NSM spread.
Insights
Antibiotic resistance is a global threat. This study found that patient colonization with multidrug-resistant organisms upon ICU admission and during their stay increases healthcare-associated infections, highlighting the need for targeted antibiotic strategies.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Microbiology
Background:
- Antibiotic resistance poses a significant global health challenge, leading to increased morbidity and mortality.
- The prevalence of multidrug-resistant microorganisms (MDROs) is rising, even in community settings, leading to patient colonization before hospital admission.
Purpose of the Study:
- To evaluate the prevalence of colonization at intensive care unit (ICU) admission and the acquisition of new colonizations during ICU stay.
- To identify risk factors associated with colonization and to assess healthcare-associated infections (HAIs) and surgical prophylaxis efficacy.
Main Methods:
- A retrospective observational study was conducted on patients admitted to a post-cardiac surgery ICU between January 1 and June 30, 2021.
- Colonization was assessed using rectal and nasal swabs at admission and every 7 days during hospitalization.
Main Results:
- 80 out of 183 patients were colonized at admission, with 46 carrying non-susceptible microorganisms (NSMs). Previous antibiotic treatment (within 3 months) was a risk factor for NSM colonization.
- One-third of surgical prophylaxis may be ineffective against identified isolates. During the ICU stay, 36 patients acquired new colonizations, with antibiotic treatment and length of stay as risk factors.
- 54 patients experienced at least one HAI, which were significantly more frequent in colonized patients. In 35/68 HAIs, the etiology was consistent with prior colonization.
Conclusions:
- Identifying patient colonization is crucial for tailoring antibiotic treatments and prophylaxis strategies.
- This knowledge can aid in preventing the spread of non-susceptible microorganisms within healthcare settings.
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