title: Acquisition of carbapenem-resistant Gram-negative bacilli in intensive care unit: predictors and molecular epidemiology.
abstract: OBJECTIVE
  We had for aim to determine the risk factors for acquiring carbapenem-intermediate or -resistant Gram-negative bacilli (CR-GNB) in an intensive care unit (ICU) and to identify the resistance mechanisms involved.
  
  
  METHODS
  We conducted an observational prospective cohort study during 6 months in medical and surgical ICUs of the Besançon Teaching Hospital. Patients with acquired CR-GNB were patients whose cultures (screening or diagnosis) became positive more than 48h after admission to the ICU. The risk factors for ICU-acquired CR-GNB were determined by multivariate logistic regression. CR-GNB isolates were typed by pulsed-field gel electrophoresis (PFGE) and screened for resistance mechanisms with phenotypic and genotypic tests.
  
  
  RESULTS
  Twenty-three of the 347 included patients had acquired a CR-GNB. The multivariate analysis revealed significant associations between this acquisition and the duration of previous treatments with piperacillin-tazobactam (adjusted odds ratio [aOR], 1.13, P=0.02) and aminoglycosides (aOR, 1.62; P=0.005), but not with carbapenems. The CR-GNB strains were identified as Pseudomonas aeruginosa (n=10), Stenotrophomonas maltophilia (n=7), and Enterobacter cloacae (n=6). No acquired carbapenemase-producing strain was identified. PFGE typing identified 1 multiple clone among P. aeruginosa isolates (4 patients), whereas for the other bacteria, all the strains were different.
  
  
  CONCLUSIONS
  Our study results suggest that the strategy to prevent the emergence and spread of CR-GNB should not be limited to the sole restriction of carbapenem use in ICU settings.
authors: Service d'hygiène hospitalière, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France.
authors: P
authors: P
authors: Marchenay
authors: Service de réanimation chirurgicale, CHRU de Besançon, 25030 Besançon, France.
authors: G
authors: G
authors: Blasco
authors: Service de réanimation médicale, CHRU de Besançon, 25030 Besançon, France.
authors: J-C
authors: JC
authors: Navellou
authors: Service d'hygiène hospitalière, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; Service des maladies infectieuses et tropicales, CHRU de Besançon, 25030 Besançon, France.
authors: J
authors: J
authors: Leroy
authors: Service d'hygiène hospitalière, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; UMR-CNRS 6249 chrono-environnement, université de Franche-Comté, 25030 Besançon, France.
authors: P
authors: P
authors: Cholley
authors: Service d'hygiène hospitalière, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; UMR-CNRS 6249 chrono-environnement, université de Franche-Comté, 25030 Besançon, France.
authors: D
authors: D
authors: Talon
authors: Service d'hygiène hospitalière, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; UMR-CNRS 6249 chrono-environnement, université de Franche-Comté, 25030 Besançon, France.
authors: X
authors: X
authors: Bertrand
authors: Service d'hygiène hospitalière, hôpital Jean-Minjoz, CHRU de Besançon, 3, boulevard Fleming, 25030 Besançon, France; UMR-CNRS 6249 chrono-environnement, université de Franche-Comté, 25030 Besançon, France. Electronic address: hhgbaguidihaore@chu-besancon.fr.
authors: H
authors: H
authors: Gbaguidi-Haore
mesh_terms: D000368:Aged; D015780:Carbapenems / Q000494:pharmacology*; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D018440:beta-Lactam Resistance
chemical_list: D015780:Carbapenems
keywords: Antibiorésistance; Antibiotic resistance; Bacilles à Gram négatif; Carbapenem use; Carbapénèmes; Cross-transmission; Gram-negative bacilli; ICU; Réanimation; Transmission croisée