Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients.
Intensive Care Med
; 39(7): 1253-61, 2013 Jul.
Article
em En
| MEDLINE
| ID: mdl-23604133
ABSTRACT
PURPOSE:
Carbapenem-resistant (CR) Gram-negative pathogens have increased substantially. This study was performed to identify the risk factors for development of CR Gram-negative bacteremia (GNB) in intensive care unit (ICU) patients.METHODS:
Prospective study; risk factors for development of CR-GNB were investigated using two groups of case patients the first group consisted of patients who acquired carbapenem susceptible (CS) GNB and the second group included patients with CR-GNB. Both case groups were compared to a shared control group defined as patients without bacteremia, hospitalized in the ICU during the same period.RESULTS:
Eighty-five patients with CR- and 84 patients with CS-GNB were compared to 630 control patients, without bacteremia. Presence of VAP (OR 7.59, 95 % CI 4.54-12.69, p < 0.001) and additional intravascular devices (OR 3.69, 95 % CI 2.20-6.20, p < 0.001) were independently associated with CR-GNB. Presence of VAP (OR 2.93, 95 % CI 1.74-4.93, p < 0.001), presence of additional intravascular devices (OR 2.10, 95 % CI 1.23-3.60, p = 0.007) and SOFA score on ICU admission (OR 1.11, 95 % CI 1.03-1.20, p = 0.006) were independently associated with CS-GNB. The duration of exposure to carbapenems (OR 1.079, 95 % CI 1.022-1.139, p = 0.006) and colistin (OR 1.113, 95 % CI 1.046-1.184, p = 0.001) were independent risk factors for acquisition of CR-GNB. When the source of bacteremia was other than VAP, previous administration of carbapenems was the only factor related with the development of CR-GNB (OR 1.086, 95 % CI 1.003-1.177, p = 0.042).CONCLUSIONS:
Among ICU patients, VAP development and the presence of additional intravascular devices were the major risk factors for CR-GNB. In the absence of VAP, prior use of carbapenems was the only factor independently related to carbapenem resistance.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Carbapenêmicos
/
Infecção Hospitalar
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Infecções por Bactérias Gram-Negativas
/
Bacteriemia
/
Resistência beta-Lactâmica
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Intensive Care Med
Ano de publicação:
2013
Tipo de documento:
Article