Clinical impact and risk factors for colonization with extended-spectrum ß-lactamase-producing bacteria in the intensive care unit.
Intensive Care Med
; 38(11): 1769-78, 2012 Nov.
Article
em En
| MEDLINE
| ID: mdl-22893223
ABSTRACT
PURPOSE:
The changed epidemiology of extended spectrum beta-lactamases (ESBL), the spread to the community and the need for prudent use of carbapenems require updated knowledge of risk factors for colonization with ESBL-producing enterobacteriaceae (ESBL-PE).METHODS:
An 8-month prospective study in the medical ICU of an 850-bed general and university-affiliated hospital.RESULTS:
Of 610 patients admitted, 531 (87 %) had a rectal swab obtained at admission, showing a 15 % (82 patients) ESBL-PE carriage rate, mostly of E. coli (n = 51, 62 %); ESBL-PE caused 9 (3 %) infections on admission. By multivariable analysis, transfer from another ICU (OR = 2.56 [1, 22]), hospital admission in another country [OR = 5.28 (1.56-17.8)], surgery within the past year [OR = 2.28 (1.34-3.86)], prior neurologic disease [OR = 2.09 (1.1-4.0)], and prior administration of third generation cephalosporin (within 3-12 months before ICU admission) [OR = 3.05 (1.21-7.68)] were independent predictive factors of colonization by ESBL-PE upon ICU admission. Twenty-eight patients (13 % of those staying for more than 5 days) acquired ESBL carriage in ICU, mostly with E. cloacae (n = 13, 46 %) and K. pneumoniae (n = 10, 36 %). In carriers, ESBL-PE caused 10 and 27 % of first and second episodes of ICU-acquired infections, respectively.CONCLUSION:
We found a high prevalence of ESBLE-PE colonization on admission to our ICU, even in the subgroup admitted from the community, but few first infections. Identifying risk factors for ESBL-PE colonization may help identifying which patients may warrant empiric ESBL-targeted antimicrobial drug therapy as a means to limit carbapenem use.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Portador Sadio
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Infecção Hospitalar
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Infecções por Enterobacteriaceae
Tipo de estudo:
Etiology_studies
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Observational_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Intensive Care Med
Ano de publicação:
2012
Tipo de documento:
Article
País de afiliação:
França