Extensively drug-resistant and multidrug-resistant gram-negative pathogens in the neurocritical intensive care unit.
Extensively drug resistant
Infection
Intensive care unit
Multidrug resistant
Retrospective study
Risk factors
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
24
08
2020
accepted:
05
10
2020
pubmed:
17
10
2020
medline:
28
4
2022
entrez:
16
10
2020
Statut:
ppublish
Résumé
Abrupt increase of multidrug-resistant, extensively drug-resistant, and pandrug-resistant bacteria may complicate the course, management, and costs of neurocritical patients and is associated with high morbidity and mortality rates. No data exists regarding risk factors for colonization by gram-negative pathogens in neurocritical patients. The aim of the study was to identify risk factors associated with colonization by multidrug-resistant, extensively drug-resistant, and pandrug-resistant gram-negative bacteria in neurocritical patients. We conducted a retrospective cohort study in a neurointensive care unit over a period of 3 years. We included adult neurocritical patients admitted for more than 48 h. We analyzed several factors including both anamnestic factors and admission diagnosis. Four hundred twenty neurocritical patients were retrospectively enrolled. Seventy-three patients developed colonization by multidrug-resistant and 53 by extensively drug-resistant gram negative pathogens. Logistic regression identified intensive care unit length of stay (LOS) as the strongest predictor for both multidrug-resistant (AUC 0.877; 95% CI 0.841-0.913) and extensively drug-resistant (AUC 0.839 0.787-0.892) gram negative pathogens. In addition, external ventricular drainage and intracerebral pressure monitoring catheter were risk factors for XDR. Survival analysis revealed that MDR bacteria colonization happens earlier (log-rank test p = 0.017). Optimization of healthcare strategies is required in order to reduce patients' length of stay to prevent multi- and extensively-drug gram-negative colonizations. Indeed, an early external ventricular drainage and intracerebral pressure monitoring catheter removal is deemed necessary as soon as clinically appropriate.
Sections du résumé
BACKGROUND
Abrupt increase of multidrug-resistant, extensively drug-resistant, and pandrug-resistant bacteria may complicate the course, management, and costs of neurocritical patients and is associated with high morbidity and mortality rates. No data exists regarding risk factors for colonization by gram-negative pathogens in neurocritical patients. The aim of the study was to identify risk factors associated with colonization by multidrug-resistant, extensively drug-resistant, and pandrug-resistant gram-negative bacteria in neurocritical patients.
METHODS
We conducted a retrospective cohort study in a neurointensive care unit over a period of 3 years. We included adult neurocritical patients admitted for more than 48 h. We analyzed several factors including both anamnestic factors and admission diagnosis.
RESULTS
Four hundred twenty neurocritical patients were retrospectively enrolled. Seventy-three patients developed colonization by multidrug-resistant and 53 by extensively drug-resistant gram negative pathogens. Logistic regression identified intensive care unit length of stay (LOS) as the strongest predictor for both multidrug-resistant (AUC 0.877; 95% CI 0.841-0.913) and extensively drug-resistant (AUC 0.839 0.787-0.892) gram negative pathogens. In addition, external ventricular drainage and intracerebral pressure monitoring catheter were risk factors for XDR. Survival analysis revealed that MDR bacteria colonization happens earlier (log-rank test p = 0.017).
CONCLUSIONS
Optimization of healthcare strategies is required in order to reduce patients' length of stay to prevent multi- and extensively-drug gram-negative colonizations. Indeed, an early external ventricular drainage and intracerebral pressure monitoring catheter removal is deemed necessary as soon as clinically appropriate.
Identifiants
pubmed: 33063159
doi: 10.1007/s00701-020-04611-3
pii: 10.1007/s00701-020-04611-3
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
859-865Informations de copyright
© 2020. Springer-Verlag GmbH Austria, part of Springer Nature.
Références
Ang H, Sun X (2018) Risk factors for multidrug-resistant gram-negative bacteria infection in intensive care units: a meta-analysis. Int J Nurs Pract 24:e12644. https://doi.org/10.1111/ijn.12644
doi: 10.1111/ijn.12644
pubmed: 29575345
Barbier F, Andremont A, Wolff M, Bouadma L (2013) Hospital-acquired pneumonia and ventilator-associated pneumonia: recent advances in epidemiology and management. Curr Opin Pulm Med 19:216–228. https://doi.org/10.1097/MCP.0b013e32835f27be
doi: 10.1097/MCP.0b013e32835f27be
pubmed: 23524477
Bouza E, Giannella M, Bunsow E et al (2012) Ventilator-associated pneumonia due to meticillin-resistant Staphylococcus aureus: risk factors and outcome in a large general hospital. J Hosp Infect 80:150–155. https://doi.org/10.1016/j.jhin.2011.11.013
doi: 10.1016/j.jhin.2011.11.013
pubmed: 22226126
Burillo A, Muñoz P, Bouza E (2019) Risk stratification for multidrug-resistant gram-negative infections in ICU patients. Curr Opin Infect Dis 32:626–637. https://doi.org/10.1097/QCO.0000000000000599
doi: 10.1097/QCO.0000000000000599
pubmed: 31567570
Fox J, Monette G (1992) Generalized collinearity diagnostics. Am Stat Assoc 87:178–183. https://doi.org/10.1080/01621459.1992.10475190
doi: 10.1080/01621459.1992.10475190
Geraldini F, De Cassai A, Correale C et al (2020) Predictors of deep-vein thrombosis in subarachnoid hemorrhage: a retrospective analysis. Acta Neurochir 162:2295–2301. https://doi.org/10.1007/s00701-020-04455-x
doi: 10.1007/s00701-020-04455-x
pubmed: 32577893
Horan TC, Andrus M, Dudeck MA (2008) CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 36:309–332. https://doi.org/10.1016/j.ajic.2008.03.002
doi: 10.1016/j.ajic.2008.03.002
pubmed: 18538699
Liu P, Li X, Luo M et al (2018) Risk factors for carbapenem-resistant Klebsiella pneumoniae infection: a meta-analysis. Microb Drug Resist 24:190–198. https://doi.org/10.1186/s13756-020-0686-0
doi: 10.1186/s13756-020-0686-0
pubmed: 28749714
pmcid: 5873294
Magiorakos AP, Srinivasan A, Carey RB et al (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18:268–281. https://doi.org/10.1111/j.1469-0691.2011.03570.x
doi: 10.1111/j.1469-0691.2011.03570.x
pubmed: 21793988
Raymond B (2019) Five rules for resistance management in the antibiotic apocalypse, a road map for integrated microbial management. Evol Appl 12:1079–1091. https://doi.org/10.1111/eva.12808
doi: 10.1111/eva.12808
pubmed: 31297143
pmcid: 6597870
Singer M, Deutschman CS, Seymour CW et al (2016) The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 315(8):801–810. https://doi.org/10.1001/jama.2016.0287
doi: 10.1001/jama.2016.0287
pubmed: 26903338
pmcid: 4968574
Topjian AA, Stuart A, Pabalan AA et al (2014) Risk factors associated with infections and need for permanent cerebrospinal fluid diversion in pediatric intensive care patients with externalized ventricular drains. Neurocrit Care 21:294–299. https://doi.org/10.1007/s12028-013-9946-7
doi: 10.1007/s12028-013-9946-7
pubmed: 24522759
pmcid: 4133323
Vasudevan A, Memon BI, Mukhopadhyay A, Li J, Tambyah PA (2015) The costs of nosocomial resistant gram negative intensive care unit infections among patients with the systemic inflammatory response syndrome- a propensity matched case control study. Antimicrob Resist Infect Control 4:3. https://doi.org/10.1186/s13756-015-0045-8
doi: 10.1186/s13756-015-0045-8
pubmed: 25653851
pmcid: 4316763
Wenzel RR, Thompson RL, Landry SM et al (1983) Hospital-acquired infections in intensive care unit patients: an overview with emphasis on epidemics. Infect Control 4:371–375. https://doi.org/10.1017/s0195941700059774
doi: 10.1017/s0195941700059774
pubmed: 6556158
Wistrand-Yuen E, Knopp M, Hjort K, Koskiniemi S, Berg OG, Andersson DI (2018) Evolution of high-level resistance during low-level antibiotic exposure. Nat Commun 9:1599. https://doi.org/10.1038/s41467-018-04059-1
doi: 10.1038/s41467-018-04059-1
pubmed: 29686259
pmcid: 5913237