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Published on: March 10, 2020
Colonization status and risk factors for infection by carbapenem-resistant Gram-negative bacteria in intensive care
Catalina Espitia-Acero1, Juan Carlos García-Betancur1, Elsa De La Cadena1
1Grupo de investigaciones en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia.
Background:
Carbapenem-resistant Gram-negative bacteria (CRGNB) are increasing globally, leading to high mortality, extended hospital stays, and higher costs. Colombia is a hotspot for carbapenem resistance, but intensive care unit (ICU) surveillance for CRGNB is limited.
Aim:
To assess the association between colonization by carbapenem-resistant organisms (CROs) on ICU admission and subsequent infection, along with other risk factors.
Methods:
A multicentre prospective cohort study was conducted in two Colombian hospitals with high carbapenem resistance. CRO colonization status was determined upon ICU admission, and statistical analyses were performed to assess relations with infection development.
Findings:
In general, 18.5% (82/442) of ICU patients were colonized by at least one CRO, with only six acquiring colonization during ICU stay. Pseudomonas spp. (70/106) and Klebsiella spp. (10/106) were the most common species; 28.3% of isolates harboured carbapenemase genes, mainly blaKPC and blaNDM. Bivariate analysis showed that readmission to the ICU (relative risk: 4.7; confidence interval 95%: 1.51-14.57) and the use of antibiotics in the last 30 days prior ICU admission (6.4; 1.76-23.13) were related to the development to bacterial infection, independently of the previous colonization status.
Conclusion:
Identifying CRO colonization status, particularly in patients with risk factors and/or with frequent hospital transit, is crucial for effective infection control within the ICU.
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