Additional risk factors for infection by multidrug-resistant pathogens in healthcare-associated infection: a large cohort study

Abstract

BackgroundThere is a lack of consensus regarding the definition of risk factors for healthcare-associated infection (HCAI). The purpose of this study was to identify additional risk factors for HCAI, which are not included in the current definition of HCAI, associated with infection by multidrug-resistant (MDR) pathogens, in all hospitalized infected patients from the community.MethodsThis 1-year prospective cohort study included all patients with infection admitted to a large, tertiary care, university hospital. Risk factors not included in the HCAI definition, and independently associated with MDR pathogen infection, namely MDR Gram-negative (MDR-GN) and ESKAPE microorganisms (vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species, carbapenem-hydrolyzing Klebsiella pneumonia and MDR Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species), were identified by logistic regression among patients admitted from the community (either with community-acquired or HCAI).ResultsThere were 1035 patients with infection, 718 from the community. Of these, 439 (61%) had microbiologic documentation; 123 were MDR (28%). Among MDR: 104 (85%) had MDR-GN and 41 (33%) had an ESKAPE infection. Independent risk factors associated with MDR and MDR-GN infection were: age (adjusted odds ratio (OR) = 1.7 and 1.5, p = 0.001 and p = 0.009, respectively), and hospitalization in the previous year (between 4 and 12 months previously) (adjusted OR = 2.0 and 1,7, p = 0.008 and p = 0.048, respectively). Infection by pathogens from the ESKAPE group was independently associated with previous antibiotic therapy (adjusted OR = 7.2, p < 0.001) and a Karnofsky index <70 (adjusted OR = 3.7, p = 0.003). Patients with infection by MDR, MDR-GN and pathogens from the ESKAPE group had significantly higher rates of inadequate antibiotic therapy than those without (46% vs 7%, 44% vs 10%, 61% vs 15%, respectively, p < 0.001).ConclusionsThis study suggests that the inclusion of additional risk factors in the current definition of HCAI for MDR pathogen infection, namely age >60 years, Karnofsky index <70, hospitalization in the previous year, and previous antibiotic therapy, may be clinically beneficial for early diagnosis, which may decrease the rate of inadequate antibiotic therapy among these patients.

Risk factors and mortality in the Carbapenem-resistant Klebsiella pneumoniae infection: case control study

“…On the other hand, non-use of glycopeptide and steroids, and the absence of tracheostomy prevented the development of CRKP. Similar factors have been defined as risk factors for CRKP infection/colonization in the literature [11][12][13][14] .…”

‘Disperse abroad in the land’: the role of wildlife in the dissemination of antimicrobial resistance

“…By contrast, 'acquired' AMR is the result of exposure to antimicrobial drugs which promotes resistance by selecting bacteria within a population with genetic traits conferring resistance. Thus, the selection of AMR in both pathogens and the normal gut microbiota of livestock and humans is believed to be largely a consequence of increased selective pressure provided by clinical antimicrobial use: recent hospitalization, for example, is a risk factor for shedding antibiotic-resistant Escherichia coli in both horses [8] and humans [9]. In many parts of the world, antimicrobials are still used, not just in clinical settings, but as 'growth promoters' in food-producing animals, an activity banned in the European Union owing to concerns about the selection of AMR [10].…”

A Rising Threat – Risk Factors and Outcomes Related to Infections With Acinetobacter Species

“…Non-random sampling method was adopted for the study. The following variables were analyzed: ICU admission, duration of stay in the hospital, mechanical ventilation, endotracheal intubation, the presence of underlying diseases or conditions, including chronic obstructive pulmonary disease (COPD), diabetes mellitus, hypertension, chronic kidney disease (CKD), chronic liver disease, ischemic heart disease, malignancy, past history of device implantation or surgery, and instrumentation at various sites such as Central venous catheters [4][5][6][7]. Ventilator-associated pneumonia (VAP) is defined according to the American Thoracic Society as pneumonia that occurs 48-72 hrs or thereafter following endotracheal intubation, characterized by the presence of a new or progressive infiltrate, signs of systemic infection (fever, altered white blood cell count), changes in sputum characteristics, and detection of a causative agent [8].…”