title: Risk factors for colonization by carbapenemase-producing enterobacteria at admission to a Surgical ICU: A retrospective study.
abstract: BACKGROUND
  In 2011, a hospital-wide outbreak of OXA-48 producing Klebsiella pneumoniae occurred in our hospital, an epidemiological setting of high ESBL-producing K. pneumoniae rates. This study identifies risk factors for colonization with carbapenemase-producing enterobacteria (CPE) at Surgical Intensive Care Unit (SICU) admission.
  
  
  METHODS
  A 2-year retrospective study was performed in all patients admitted to the SICU that following routine had a rectal swab collected upon admission.
  
  
  RESULTS
  Of 254 patients admitted, 41 (16.1%) harbored CPE (five showing two carbapenemase-producing isolates). Most frequent carbapenemase-producing isolates and carbapenemases were K. pneumoniae (39/46, 84.8%) and OXA-48 (31/46; 76.1%), respectively. Carriers significantly had higher rates of chronic renal disease, previous digestive/biliary endoscopy, hospitalization, ICU/SICU admission, intraabdominal surgery, and antibiotic intake, as well as higher median values of clinical scores (SOFA, SAPS II and APACHE II). In the multivariate analysis (R2=0.309, p<0.001), CPE carriage was associated with prior administration of 3rd-4th generation cephalosporins (OR=27.96, 95%CI=6.88, 113.58, p<0.001), β-lactam/β-lactamase inhibitor (OR=11.71, 95%CI=4.51, 30.43, p<0.001), abdominal surgery (OR=6.33, 95%CI=2.12, 18.89, p=0.001), and prior digestive/biliary endoscopy (OR=3.88, 95%CI=1.56, 9.67, p=0.004).
  
  
  CONCLUSIONS
  A strong association between production of ESBLs and carriage of CPE (mainly OXA-48 producing K. pneumoniae) was found. According to the model, the co-selection of β-lactamases by previous exposure to broad-spectrum cephalosporins and β-lactam/β-lactamase inhibitors (with lower relative risk), abdominal surgery and prior digestive/biliary endoscopy were factors associated with CPE carriage.
authors.affiliation: Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain. Electronic address: emilio.maseda@gmail.com.
authors.forename: Emilio
authors.initials: E
authors.lastname: Maseda
authors.affiliation: Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Salgado
authors.affiliation: Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Anillo
authors.affiliation: Microbiology Dpt., Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Carrascoso
authors.affiliation: Microbiology Dpt., Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Gómez-Gil
authors.affiliation: General Medicine Dpt., Hospital Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Martín-Funke
authors.affiliation: PRISM-AG, Madrid, Spain.
authors.forename: Maria-Jose
authors.initials: MJ
authors.lastname: Gimenez
authors.affiliation: Preventive Medicine Dpt., Hospital Infanta Cristina, Madrid, Spain.
authors.forename: Juan-José
authors.initials: JJ
authors.lastname: Granizo
authors.affiliation: PRISM-AG, Madrid, Spain.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Aguilar
authors.affiliation: Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Gilsanz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins / Q000032:analysis*; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D012007:Rectum / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000032:analysis*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase; C108449:oxacillinase
keywords: BLEE; Carbapenemasas; Carbapenemases; Carriage; ESBL; Klebsiella pneumoniae; OXA-48; Portadores; Surgical ICU; Unidad de Cuidados Críticos Quirúrgicos