Acquisition of carbapenem-resistant Gram-negative bacilli in intensive care unit: predictors and molecular epidemiology.
Med Mal Infect
; 45(1-2): 34-40, 2015.
Article
em En
| MEDLINE
| ID: mdl-25640914
ABSTRACT
OBJECTIVES:
We had for aim to determine the risk factors for acquiring carbapenem-intermediate or -resistant Gram-negative bacilli (CR-GNB) in an intensive care unit (ICU) and to identify the resistance mechanisms involved. PATIENTS ANDMETHODS:
We conducted an observational prospective cohort study during 6 months in medical and surgical ICUs of the Besançon Teaching Hospital. Patients with acquired CR-GNB were patients whose cultures (screening or diagnosis) became positive more than 48h after admission to the ICU. The risk factors for ICU-acquired CR-GNB were determined by multivariate logistic regression. CR-GNB isolates were typed by pulsed-field gel electrophoresis (PFGE) and screened for resistance mechanisms with phenotypic and genotypic tests.RESULTS:
Twenty-three of the 347 included patients had acquired a CR-GNB. The multivariate analysis revealed significant associations between this acquisition and the duration of previous treatments with piperacillin-tazobactam (adjusted odds ratio [aOR], 1.13, P=0.02) and aminoglycosides (aOR, 1.62; P=0.005), but not with carbapenems. The CR-GNB strains were identified as Pseudomonas aeruginosa (n=10), Stenotrophomonas maltophilia (n=7), and Enterobacter cloacae (n=6). No acquired carbapenemase-producing strain was identified. PFGE typing identified 1 multiple clone among P. aeruginosa isolates (4 patients), whereas for the other bacteria, all the strains were different.CONCLUSION:
Our study results suggest that the strategy to prevent the emergence and spread of CR-GNB should not be limited to the sole restriction of carbapenem use in ICU settings.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Carbapenêmicos
/
Resistência beta-Lactâmica
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Bactérias Gram-Negativas
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Unidades de Terapia Intensiva
Tipo de estudo:
Etiology_studies
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Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Limite:
Aged
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Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Med Mal Infect
Ano de publicação:
2015
Tipo de documento:
Article
País de afiliação:
França