title: Risk factors for tracheobronchial acquisition of resistant Gram-negative bacterial pathogens in mechanically ventilated ICU patients.
abstract: The aim of this study was to identify risk factors for tracheobronchial acquisition with the most common resistant Gram-negative bacteria in the intensive care unit (ICU) during the first week after intubation and mechanical ventilation. Tracheobronchial and oropharyngeal cultures were obtained at admission, after 48 hours, and after 7 days of mechanical ventilation. Patient characteristics, interventions, and antibiotic usage were recorded. Among 71 eligible patients with two negative bronchial cultures for resistant Gram-negative bacteria (at admission and within 48 hours), 41 (58%) acquired bronchial resistant Gram-negative bacteria by day 7. Acquisition strongly correlated with presence of the same pathogens in the oropharynx: Acinetobacter baumannii [odds ratio (OR) = 20·2, 95% confidence interval (CI): 5·5-73·6], Klebsiella pneumoniae (OR = 8·0, 95% CI: 1·9-33·6), and Pseudomonas aeruginosa (OR = 27, 95%: CI 2·7-273). Bronchial acquisition with resistant K. pneumoniae also was associated with chronic liver disease (OR = 3·9, 95% CI: 1·0-15·3), treatment with aminoglycosides (OR = 4·9, 95% CI: 1·4-18·2), tigecycline (OR = 4·9, 95% CI: 1·4-18·2), and linezolid (OR = 3·9, 95% CI: 1·1-15·0). In multivariate analysis, treatment with tigecycline and chronic liver disease were independently associated with bronchial resistant K. pneumoniae acquisition. Our results show a high incidence of tracheobronchial acquisition with resistant Gram-negative microorganisms in the bronchial tree of newly intubated patients. Oropharynx colonization with the same pathogens and specific antibiotics use were independent risk factors.
authors: Ilias
authors: I
authors: Papakonstantinou
authors: Epameinondas
authors: E
authors: Angelopoulos
authors: Ioannis
authors: I
authors: Baraboutis
authors: Efstathia
authors: E
authors: Perivolioti
authors: Maria
authors: M
authors: Parisi
authors: Zoe
authors: Z
authors: Psaroudaki
authors: Efstathia
authors: E
authors: Kampisiouli
authors: Athina
authors: A
authors: Argyropoulou
authors: Serafeim
authors: S
authors: Nanas
authors: Christina
authors: C
authors: Routsi
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001980:Bronchi / Q000187:drug effects / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology / Q000635:transmission*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014132:Trachea / Q000187:drug effects / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antimicrobial agents; Gram-negative bacteria,; Intensive care unit,; Klebsiella pneumoniae,; Multidrug resistance,; Respiratory,