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Fernández-Martínez NF, Cárcel-Fernández S, De la Fuente-Martos C, Ruiz-Montero R, Guzmán-Herrador BR, León-López R, Gómez FJ, Guzmán-Puche J, Martínez-Martínez L, Salcedo-Leal I. Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1039. [PMID: 35162062 PMCID: PMC8834020 DOI: 10.3390/ijerph19031039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 01/27/2023]
Abstract
Multidrug-resistant Gram-negative bacteria (MDR-GNB) are microorganisms that have acquired resistance to extended-spectrum antibacterials and constitute an emerging threat to public health. Although carriers are an important source of transmission in healthcare settings, data about risk factors for MDR-GNB carriage are limited. Therefore, we aimed to identify risk factors for MDR-GNB carriage upon intensive care unit (ICU) admission and to optimise screening strategies. We conducted a case-control study. Admissions of adult patients to the ICU of a 1000-bed hospital during a year were included. We collected sociodemographic, clinical and microbiological data and performed a multivariate logistic regression model. A total of 1342 patients resulted in 1476 episodes of ICU admission, 91 (6.2%) of whom harboured MDR-GNB (38.5% women; median age 63.9 years). The most frequently isolated pathogens were Escherichia coli (57%) and Klebsiella pneumoniae (16%). The most frequent resistance mechanism was production of extended-spectrum beta lactamases. MDR-GNB carriage was associated to liver cirrhosis (OR 6.54, 95% CI 2.17-19.17), previous MDR-GNB carriage (OR 5.34, 1.55-16.60), digestive surgery (OR 2.83, 1.29-5.89) and length of hospital stay (OR 1.01 per day, 1.00-1.03). Several risk factors for MDR-GNB carriage upon admission to a high-risk setting were identified; the main comorbidity was liver cirrhosis.
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Affiliation(s)
- Nicolás Francisco Fernández-Martínez
- Preventive Medicine and Public Health Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain; (N.F.F.-M.); (B.R.G.-H.); (I.S.-L.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
| | - Sheila Cárcel-Fernández
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Intensive Care Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Department of Medicine, University of Granada, 18011 Granada, Spain;
| | - Carmen De la Fuente-Martos
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Intensive Care Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain
| | - Rafael Ruiz-Montero
- Preventive Medicine and Public Health Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain; (N.F.F.-M.); (B.R.G.-H.); (I.S.-L.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Department of Medical and Surgical Sciences, University of Córdoba, 14004 Córdoba, Spain
| | - Bernardo R. Guzmán-Herrador
- Preventive Medicine and Public Health Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain; (N.F.F.-M.); (B.R.G.-H.); (I.S.-L.)
| | - Rafael León-López
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Intensive Care Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain
| | | | - Julia Guzmán-Puche
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Microbiology Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Carlos III Research Institute, 28029 Majadahonda, Spain
| | - Luis Martínez-Martínez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Microbiology Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Carlos III Research Institute, 28029 Majadahonda, Spain
- Department of Agricultural Chemistry, Soil Science and Microbiology, University of Córdoba, 14004 Córdoba, Spain
| | - Inmaculada Salcedo-Leal
- Preventive Medicine and Public Health Unit, Reina Sofía University Hospital, 14004 Córdoba, Spain; (N.F.F.-M.); (B.R.G.-H.); (I.S.-L.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain; (S.C.-F.); (C.D.l.F.-M.); (R.L.-L.); (J.G.-P.); (L.M.-M.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Carlos III Research Institute, 28029 Majadahonda, Spain
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