title: Burden of highly resistant microorganisms in a Dutch intensive care unit.
abstract: BACKGROUND
  The occurrence of highly resistant microorganisms (HRMOs) is a major threat to critical care patients, leading to worse outcomes, need for isolation measures, and demand for second-line or rescue antibiotics. The aim of this study was to quantify the burden of HRMOs in an intensive care unit (ICU) for adult patients in a university hospital in the Netherlands. We evaluated local distribution of different HRMO categories and proportion of ICU-imported versus ICU- acquired HRMOs. Outcome of HRMO-positive patients versuscontrols was compared.
  
  
  METHODS
  In this prospective single-centre study, culture results of all ICU patients during a four-month period were recorded, as well as APACHE scores, ICU mortality and length of stay (LOS) in the ICU.
  
  
  RESULTS
  58 of 962 (6.0%) patients were HRMO positive during ICU stay. The majority (60%) of those patients were HRMO positive on ICU admission. HRMO-positive patients had significantly higher APACHE scores, longer LOS and higher mortality compared with controls.
  
  
  CONCLUSIONS
  Our study suggests that a large part of antibiotic resistance in the ICU is imported. This underscores the importance of a robust surveillance and infection control program throughout the hospital, and implies that better recognition of those at risk for HRMO carriage before ICU admission may be worthwhile. Only a small minority of patients with HRMO at admission did not have any known risk factors for HRMO.
authors.affiliation: Department of Critical Care, University Medical Center Groningen, the Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Aardema
authors.forename: J P
authors.initials: JP
authors.lastname: Arends
authors.forename: A M G A
authors.initials: AM
authors.lastname: de Smet
authors.forename: J G
authors.initials: JG
authors.lastname: Zijlstra
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D024881:Drug Resistance, Bacterial / Q000502:physiology*; D004352:Drug Resistance, Microbial; D004755:Enterobacteriaceae / Q000502:physiology; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D004926:Escherichia coli / Q000502:physiology; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D007709:Klebsiella / Q000502:physiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D011549:Pseudomonas / Q000502:physiology; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D065507:Vancomycin-Resistant Enterococci; D055815:Young Adult