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Wu YL, Hu XQ, Wu DQ, Li RJ, Wang XP, Zhang J, Liu Z, Chu WW, Zhu X, Zhang WH, Zhao X, Guan ZS, Jiang YL, Wu JF, Cui Z, Zhang J, Li J, Wang RM, Shen SH, Cai CY, Zhu HB, Jiang Q, Zhang J, Niu JL, Xiong XP, Tian Z, Zhang JS, Zhang JL, Tang LL, Liu AY, Wang CX, Ni MZ, Jiang JJ, Yang XY, Yang M, Zhou Q. Prevalence and risk factors for colonisation and infection with carbapenem-resistant Enterobacterales in intensive care units: A prospective multicentre study. Intensive Crit Care Nurs 2023; 79:103491. [PMID: 37480701 DOI: 10.1016/j.iccn.2023.103491] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES This study aimed to investigate the prevalence and risk factors for carbapenem-resistant Enterobacterales colonisation/infection at admission and acquisition among patients admitted to the intensive care unit. RESEARCH METHODOLOGY/DESIGN A prospective and multicentre study. SETTING This study was conducted in 24 intensive care units in Anhui, China. MAIN OUTCOME MEASURES Demographic and clinical data were collected, and rectal carbapenem-resistant Enterobacterales colonisation was detected by active screening. Multivariate logistic regression models were used to analyse factors associated with colonisation/infection with carbapenem-resistant Enterobacterales at admission and acquisition during the intensive care unit stay. RESULTS There were 1133 intensive care unit patients included in this study. In total, 5.9% of patients with carbapenem-resistant Enterobacterales colonisation/infection at admission, and of which 56.7% were colonisations. Besides, 8.5% of patients acquired carbapenem-resistant Enterobacterales colonisation/infection during the intensive care stay, and of which 67.6% were colonisations. At admission, transfer from another hospital, admission to an intensive care unit within one year, colonisation/infection/epidemiological link with carbapenem-resistant Enterobacterales within one year, and exposure to any antibiotics within three months were risk factors for colonisation/infection with carbapenem-resistant Enterobacterales. During the intensive care stay, renal disease, an epidemiological link with carbapenem-resistant Enterobacterales, exposure to carbapenems and beta-lactams/beta-lactamase inhibitors, and intensive care stay of three weeks or longer were associated with acquisition. CONCLUSION The prevalence of colonisation/infection with carbapenem-resistant Enterobacterales in intensive care units is of great concern and should be monitored systematically. Particularly for the 8.5% prevalence of carbapenem-resistant Enterobacterales acquisition during the intensive care stay needs enhanced infection prevention and control measures in these setting. Surveillance of colonisation/infection with carbapenem-resistant Enterobacterales at admission and during the patient's stay represents an early identification tool to prevent further transmission of carbapenem-resistant Enterobacterales. IMPLICATIONS FOR CLINICAL PRACTICE Carbapenem-resistant Enterobacterales colonization screening at admission and during the patient's stay is an important tool to control carbapenem-resistant Enterobacterales spread in intensive care units.
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Affiliation(s)
- Yi-Le Wu
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiao-Qian Hu
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - De-Quan Wu
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ruo-Jie Li
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xue-Ping Wang
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jin Zhang
- The Second Department of Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhou Liu
- Department of Clinical Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen-Wen Chu
- Department of Clinical Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xi Zhu
- Department of Pharmacology, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wen-Hui Zhang
- The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xue Zhao
- The Fourth Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zi-Shu Guan
- Anhui No.2 Provincial People's Hospital, Hefei, Anhui, China
| | - Yun-Lan Jiang
- Department of Hospital Infection Prevention and Control, the First People's Hospital of Anqing, Anqing, Anhui, China
| | - Jin-Feng Wu
- Department of Hospital Infection Prevention and Control, Anqing Municipal Hospital, Anqing, Anhui, China
| | - Zhuo Cui
- Department of Hospital Infection Prevention and Control, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Ju Zhang
- Department of Hospital Infection Prevention and Control, The First People's Hospital of Bengbu, Bengbu, Anhui, China
| | - Jia Li
- Department of Hospital Infection Prevention and Control, The Third People's Hospital of Bengbu, Bengbu, Anhui, China
| | - Ru-Mei Wang
- Department of Hospital Infection Prevention and Control, The First People's Hospital of Chuzhou, Chuzhou, Anhui, China
| | - Shi-Hua Shen
- Department of Hospital Infection Prevention and Control, Fuyang People's Hospital, Fuyang, Anhui, China
| | - Chao-Yang Cai
- Department of Hospital Infection Prevention and Control, The Second People's Hospital of Hefei, Hefei, Anhui, China
| | - Hai-Bin Zhu
- Department of Hospital Infection Prevention and Control, The First People's Hospital of Huainan City, Huainan, Anhui, China
| | - Quan Jiang
- Department of Clinical Laboratory Medicine, Huainan Xinhua Medical Group, Huainan, Anhui, China
| | - Jing Zhang
- Department of Hospital Infection Prevention and Control, Huaibei People's Hospital, Huaibei, Anhui, China
| | - Jia-Lan Niu
- Department of Hospital Infection Prevention and Control, The First People's Hospital of Huoqiu County, Huoqiu, Anhui, China
| | - Xian-Peng Xiong
- Department of Hospital Infection Prevention and Control, Lu'an People's Hospital, Lu'an, Anhui, China
| | - Zhen Tian
- Department of Hospital Infection Prevention and Control, Suzhou Municipal Hospital, Suzhou, Anhui, China
| | - Jian-She Zhang
- Department of Hospital Infection Prevention and Control, Taihe County People's Hospital, Taihe, Anhui, China
| | - Jun-Lin Zhang
- Department of Hospital Infection Prevention and Control, Tongling People's Hospital, Tongling, Anhui, China
| | - Li-Ling Tang
- Department of Hospital Infection Prevention and Control, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - An-Yun Liu
- Department of Hospital Infection Prevention and Control, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Cheng-Xiang Wang
- Department of Hospital Infection Prevention and Control, The First People's Hospital of Wuhu, Wuhu, Anhui, China
| | - Ming-Zhu Ni
- Department of Hospital Infection Prevention and Control, The Second People's Hospital of Wuhu, Wuhu, Anhui, China
| | - Jing-Jing Jiang
- Department of Hospital Infection Prevention and Control, Xuancheng People's Hospital, Xuancheng, Anhui, China
| | - Xi-Yao Yang
- Department of Hospital Infection Prevention and Control, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Min Yang
- The Second Department of Critical Care Medicine, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
| | - Qiang Zhou
- Department of Clinical Laboratory, the Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
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Papathanakos G, Andrianopoulos I, Xenikakis M, Papathanasiou A, Koulenti D, Blot S, Koulouras V. Clinical Sepsis Phenotypes in Critically Ill Patients. Microorganisms 2023; 11:2165. [PMID: 37764009 PMCID: PMC10538192 DOI: 10.3390/microorganisms11092165] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Sepsis, defined as the life-threatening dysregulated host response to an infection leading to organ dysfunction, is considered as one of the leading causes of mortality worldwide, especially in intensive care units (ICU). Moreover, sepsis remains an enigmatic clinical syndrome, with complex pathophysiology incompletely understood and a great heterogeneity both in terms of clinical expression, patient response to currently available therapeutic interventions and outcomes. This heterogeneity proves to be a major obstacle in our quest to deliver improved treatment in septic critical care patients; thus, identification of clinical phenotypes is absolutely necessary. Although this might be seen as an extremely difficult task, nowadays, artificial intelligence and machine learning techniques can be recruited to quantify similarities between individuals within sepsis population and differentiate them into distinct phenotypes regarding not only temperature, hemodynamics or type of organ dysfunction, but also fluid status/responsiveness, trajectories in ICU and outcome. Hopefully, we will eventually manage to determine both the subgroup of septic patients that will benefit from a therapeutic intervention and the correct timing of applying the intervention during the disease process.
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Affiliation(s)
- Georgios Papathanakos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Ioannis Andrianopoulos
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Menelaos Xenikakis
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Athanasios Papathanasiou
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
| | - Despoina Koulenti
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QL 4029, Australia;
- Second Critical Care Department, Attikon University Hospital, Rimini Street, 12462 Athens, Greece
| | - Stijn Blot
- Department of Internal Medicine & Pediatrics, Ghent University, 9000 Ghent, Belgium;
| | - Vasilios Koulouras
- Department of Intensive Care Medicine, University Hospital of Ioannina, 45500 Ioannina, Greece; (I.A.); (M.X.); (A.P.); (V.K.)
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