title: Risk factors for faecal carriage of Klebsiella pneumoniae producing extended spectrum beta-lactamase (ESBL-KP) in the intensive care unit.
abstract: In the course of an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) in an intensive care unit (ICU), we conducted active surveillance to determine the risk factors for ESBL-KP faecal colonization of patients. We used weekly rectal samples during a four-month period. ESBL-KP was found in the faeces of 72 of 188 (38%) patients, and 42 (58%) of them were colonized within the first week of admission to the ICU. The probability of remaining free of faecal colonization was less than 20% at 30 days of ICU admission. The risk factors associated with ESBL-KP faecal colonization were clinical severity score at admission (P = 0.004), arterial catheterization (P = 0.002), total parenteral nutrition (P = 0.04), urinary catheterization (P = 0.01), mechanical ventilation (P < 0.001), and previous antibiotic therapy (P = 0.04). A logistic regression analysis identified duration of urinary catheterization (OR:3.5; 95% CI 1.2-10.3) and mechanical ventilation (OR:4.6; 95% CI 1.1-19.3) as independent risk factors for ESBL-KP faecal colonization. Our results suggest that in an ESBL-KP prevalent environment, manipulations that facilitate cross-infection are the most relevant in the acquisition of the micro-organism and risk increases throughout hospitalization.
authors.affiliation: Infectious Disease Service, Hospital de Bellvitge, Universidad de Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Peña
authors.forename: M
authors.initials: M
authors.lastname: Pujol
authors.forename: A
authors.initials: A
authors.lastname: Ricart
authors.forename: C
authors.initials: C
authors.lastname: Ardanuy
authors.forename: J
authors.initials: J
authors.lastname: Ayats
authors.forename: J
authors.initials: J
authors.lastname: Liñares
authors.forename: F
authors.initials: F
authors.lastname: Garrigosa
authors.forename: J
authors.initials: J
authors.lastname: Ariza
authors.forename: F
authors.initials: F
authors.lastname: Gudiol
mesh_terms: D000328:Adult; D000368:Aged; D002353:Carrier State; D003428:Cross Infection / Q000209:etiology*; D004196:Disease Outbreaks; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000209:etiology*; D007711:Klebsiella pneumoniae; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D001618:beta-Lactamases
chemical_list: D001618:beta-Lactamases