First multicenter study on multidrug resistant bacteria carriage in Chinese ICUs.
BACKGROUND
The importance of multidrug-resistant organisms (MDRO) in Chinese hospitals is not clearly delineated. Thus we sought to assess the prevalence of MDRO in Chinese intensive care units (ICUs).


METHODS
Prospective study of inpatients admitted consecutively to eight ICUs in four Chinese cities in 2009-10. Admission and weekly screenings were performed by using selective media for methicillin resistant Staphylococcus aureus, extended-spectrum beta-lactamase-producing Enterobacteriaceae, Acinetobacter and Pseudomonas aeruginosa. For the two latters, resistance to ceftazidime defined MDRO. Backward logistic regression models were designed to assess factors independently associated with MDRO carriage on admission and MDRO acquisition within ICUs.


RESULTS
686 patients were included, and the MDRO prevalence rate on admission was 30.5 % (32.7 % for ESBL-positive Enterobacteriaceae, 3.2 % for MRSA). Antibiotic treatment prior to ICU admission was independently associated with carriage on admission (OR: 1.4) in multivariate analysis. A total of 104 patients acquired ≥1 MDRO in ICU (overall attack rate: 23.7 %; 14.9 % for ESBL-positive Enterobacteriaceae, and 5.1 % for MRSA). The MDRO attack rate increased from 13.2 % in the first week to 82.1 % for ICU stay > 3 weeks. Duration of antibiotic exposure (OR: 1.16; 1.1-1.2) and prior antibiotic treatment before ICU (OR: 2.1; 1.1-3.3) were associated with MDRO acquisition in multivariate analysis. The MDRO prevalence rate on ICU discharge was 51.2 % and the global prevalence density rate 71 per 1000 hospital-days.


CONCLUSIONS
More than one out of two patients was MDRO carrier on ICU discharge in Chinese hospitals. This is the result of the combination of a high MDRO prevalence rate on ICU admission and a high MDRO acquisition rate within ICU.
Peking Union Medical College Hospital, Beijing, China. drmaxiaojun@gmail.com.
Xiaojun
X
Ma
Peking University People's Hospital, Beijing, China. wuyinghong0659@163.com.
Yinghong
Y
Wu
Peking University First Hospital, Beijing, China. lucyliuyi@263.net.
Liuyi
L
Li
China-Japan Friendship Hospital, Beijing, China. xuqian356@sohu.com.
Qian
Q
Xu
Zhongshan Hospital Fudan University, Shanghai, China. hubijie@vip.sina.com.
Bijie
B
Hu
Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. yuxing_ni@126.com.
Yuxing
Y
Ni
Xiangya Hospital, Central South University, Changsha, China. dr_wuanhua@sina.com.
Anhua
A
Wu
Nanfang Hospital, Southern Medical University, Guandong, China. sunshumei99@126.com.
Shumei
S
Sun
Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France. vincent.jarlier@aphp.fr.|Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bacteriology), F-75013, Paris, France. vincent.jarlier@aphp.fr.
Vincent
V
Jarlier
Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France. jerome.robert@aphp.fr.|Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bacteriology), F-75013, Paris, France. jerome.robert@aphp.fr.
Jérôme
J
Robert
D000150:Acinetobacter / Q000302:isolation & purification; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002681:China / Q000453:epidemiology; D003428:Cross Infection / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000302:isolation & purification; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult; D018440:beta-Lactam Resistance