Colonization pressure as a risk factor of ICU-acquired multidrug resistant bacteria: a prospective observational study

Abstract

The primary objective of this study was to evaluate the impact of colonization pressure on intensive care unit (ICU)-acquired multidrug resistant bacteria (MDRB). All patients hospitalized for more than 48 h in the ICU were included in this prospective observational study. MDRB were defined as methicillin resistant Staphylococcus aureus, Pseudomonas aeruginosa resistant to ceftazidime or imipenem, Gram-negative bacilli producing extended-spectrum beta-lactamases (ESBL), and all strains of Acinetobacter baumannii and Stenotrophomonas maltophilia. Colonization pressure was daily calculated in the three participating ICUs. Univariate and multivariate analyses were used to determine risk factors for ICU-acquired MDRB. Two hundreds and four (34%) of the 593 included patients acquired an MDRB during their ICU stay. Multivariate analysis identified colonization pressure as an independent risk factor for ICU-acquired MDRB (OR (95% CI) 4.18 (1.03-17.01), p = 0.046). Other independent risk factors for ICU-acquired MDRB were mechanical ventilation (3.08 (1.28-7.38), p = 0.012), and arterial catheter use (OR, 3.04 (1.38-6.68), p = 0.006). ICU-acquired MDRB were associated with increased mortality, duration of mechanical ventilation, and ICU stay. However, ICU-acquired MDRB was not independently associated with ICU-mortality. Colonization pressure is an independent risk factor for acquiring MDRB in the ICU.

Screening for Intestinal Carriage of Extended-spectrum Beta-lactamase–producing Enterobacteriaceae in Critically Ill Patients: Expected Benefits and Evidence-based Controversies

“…Thus, carriage prevalence at ICU admission is rapidly increasing, and now commonly reaches 10-15% in Europe and up to 40% in certain Asian countries [6], although marked fluctuations are observed depending on the hospital location and case mix ( Supplementary Table S1). Of note, the prevalence of imported carriage in a given ICU has been linked to the likelihood of ESBL-E acquisition among patients not colonized at admission, a phenomenon referred as to colonization pressure [7,8]. This, along with variations in infection control policies, may explain why the average in-ICU acquisition rates remain quite limited in Europe and the Americas (ie, 3-4%) while exceeding 20% in high-prevalence areas [9] (Supplementary Table S1).…”

Preventing Transmission of Multidrug-Resistant Pathogens in the Intensive Care Unit

“…Colonization pressure, or the proportion of patients in a given unit who are colonized with resistant bacteria, is an independent risk factor for transmission. 13,14 Resistant organisms are generally thought to be transmitted from person to person via the hands of health care personnel, or from contaminated patient care equipment or contaminated surfaces in the health care environment. Antimicrobial stewardship, hand hygiene, and proper disinfection of equipment and hospital surfaces are thus important means of preventing spread.…”

Antibiotic Resistance Surveillance of Clinical Isolates of Stenotrophomonas maltophilia Strains in the Central South of China from 2016 to 2019

“…Not long ago, non-fermentative bacteria (P. aeruginosa, Acinetobacter, S. maltophilia and Alcaligenes) have been progressively identified as a decisive reason for hospital infection (14). Various dilemmas are confronted with the therapy of these infections by virtue of multiplex antibi- Stenotrophomonas maltophilia can stick to synthetic facades and develop biofilms, and undoubtedly it has been determined on various hospital equipment just as mechanical ventilation pipeline, arterial catheters, and urinary catheters (20). Most of these body surface-colonized patients in hospital were orally-infected (16/20, 80%) followed by rectal (10.0%) colonization and nasal colonization (10.0%), independently (21).…”