Risk factors for carbapenem-resistant Gram-negative bacteremia in intensive care unit patients |
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Authors: | Christina Routsi Maria Pratikaki Evangelia Platsouka Christina Sotiropoulou Vasileios Papas Theodoros Pitsiolis Athanassios Tsakris Serafeim Nanas Charis Roussos |
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Affiliation: | 1. First Department of Critical Care, Medical School, University of Athens, Evangelismos Hospital, 45-47 Ipsilantou Str., 106 76, Athens, Greece 2. Department of Microbiology, Evangelismos Hospital, Athens, Greece 4. Department of Microbiology, Konstantopouleio General Hospital, Athens, Greece 3. Department of Microbiology, Medical School, University of Athens, Athens, Greece
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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. |
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