title: Risk factors for Pseudomonas aeruginosa acquisition in intensive care units: a prospective multicentre study.
abstract: BACKGROUND
  Pseudomonas aeruginosa is a major nosocomial pathogen in intensive care units (ICUs); however, endogenous versus exogenous origin of contamination remains unclear.
  
  
  OBJECTIVE
  To identify individual and environmental ICU risk factors for P. aeruginosa acquisition.
  
  
  METHODS
  A five-month prospective multicentric study was performed in ten French ICUs. Adult patients hospitalized in ICU for ≥ 24 h were included and screened for P. aeruginosa colonization on admission, weekly and before discharge. P. aeruginosa acquisition was defined by a subsequent colonization or infection if screening swabs on admission were negative. Water samples were obtained weekly on water taps of the ICUs. Data on patient characteristics, invasive devices exposure, antimicrobial therapy, P. aeruginosa water and patient colonization pressures, and ICU characteristics were collected. Hazard ratios (HRs) were estimated using multivariate Cox model.
  
  
  RESULTS
  Among the 1314 patients without P. aeruginosa on admission, 201 (15%) acquired P. aeruginosa during their ICU stay. Individual characteristics significantly associated with P. aeruginosa acquisition were history of previous P. aeruginosa infection or colonization, cumulative duration of mechanical ventilation and cumulative days of antibiotics not active against P. aeruginosa. Environmental risk factors for P. aeruginosa acquisition were cumulative daily ward 'nine equivalents of nursing manpower use score' (NEMS) [hazard ratio (HR): 1.47 for ≥ 30 points; 95% confidence interval (CI): 1.06-2.03] and contaminated tap water in patient's room (HR: 1.76; CI: 1.09-2.84).
  
  
  CONCLUSIONS
  Individual risk factors and environmental factors for which intervention is possible were identified for P. aeruginosa acquisition.
authors.affiliation: CHU, CCLIN Sud-Ouest, Bordeaux, France; INSERM U657, Université de Bordeaux, Bordeaux, France. Electronic address: anne-gaelle.venier@chu-bordeaux.fr.
authors.forename: A-G
authors.initials: AG
authors.lastname: Venier
authors.affiliation: CHU, Hygiène hospitalière, Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Leroyer
authors.affiliation: CHU, Hygiène hospitalière, Besançon, France.
authors.forename: C
authors.initials: C
authors.lastname: Slekovec
authors.affiliation: CHU, Hygiène hospitalière, Besançon, France.
authors.forename: D
authors.initials: D
authors.lastname: Talon
authors.affiliation: CHU, Hygiène hospitalière, Besançon, France.
authors.forename: X
authors.initials: X
authors.lastname: Bertrand
authors.affiliation: CHU, Hygiène hospitalière, Montpellier, France.
authors.forename: S
authors.initials: S
authors.lastname: Parer
authors.affiliation: CH DRon, Réanimation et maladies infectieuses, Tourcoing, France.
authors.forename: S
authors.initials: S
authors.lastname: Alfandari
authors.affiliation: CHU Lariboisière, AP-HP, Hygiène hospitalière, Paris, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Guerin
authors.affiliation: CHU Lariboisière, AP-HP, Réanimation médicale, Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Megarbane
authors.affiliation: CHU Poincaré, AP-HP, Hygiène hospitalière, Garches, France.
authors.forename: C
authors.initials: C
authors.lastname: Lawrence
authors.affiliation: CHU Poincaré, AP-HP, Réanimation médicale, Garches, France.
authors.forename: B
authors.initials: B
authors.lastname: Clair
authors.affiliation: CHU Lyon Sud, Réanimation médicale, Lyon, France.
authors.forename: A
authors.initials: A
authors.lastname: Lepape
authors.affiliation: CHU Lyon Hôpital E. Herriot, Laboratoire d'hygiène, Lyon, France.
authors.forename: M
authors.initials: M
authors.lastname: Perraud
authors.affiliation: CHU Lyon Hôpital E. Herriot, Laboratoire d'hygiène, Lyon, France.
authors.forename: P
authors.initials: P
authors.lastname: Cassier
authors.affiliation: CH Lens, Hygiène hospitalière, Lens, France.
authors.forename: D
authors.initials: D
authors.lastname: Trivier
authors.affiliation: CHU, Réanimation médicale, Bordeaux, France.
authors.forename: A
authors.initials: A
authors.lastname: Boyer
authors.affiliation: CHU, Laboratoire de bactériologie, Bordeaux, France; UMR 5234 CNRS, Université de Bordeaux, Bordeaux, France.
authors.forename: V
authors.initials: V
authors.lastname: Dubois
authors.affiliation: CHU, Unité de soutien méthodologique à la recherche clinique et épidémiologique, Bordeaux, France.
authors.forename: J
authors.initials: J
authors.lastname: Asselineau
authors.affiliation: INSERM U657, Université de Bordeaux, Bordeaux, France; CHU, Hygiène hospitalière, Bordeaux, France.
authors.forename: A-M
authors.initials: AM
authors.lastname: Rogues
authors.affiliation: CHU, Unité de soutien méthodologique à la recherche clinique et épidémiologique, Bordeaux, France; INSERM, U897 Epidemiologie et Biostatistique, Bordeaux, France; Univ Bordeaux, ISPED, Bordeaux, France.
authors.forename: R
authors.initials: R
authors.lastname: Thiébaut
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D004866:Equipment Contamination; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000209:etiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects; D012121:Respiration, Artificial / Q000009:adverse effects*; D012307:Risk Factors; D014871:Water Microbiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Cross-transmission; Hospital environment; Infection control; Intensive care unit; Pseudomonas aeruginosa