title: Colonization pressure as a risk factor of ICU-acquired multidrug resistant bacteria: a prospective observational study.
abstract: The primary objective of this study was to evaluate the impact of colonization pressure on intensive care unit (ICU)-acquired multidrug resistant bacteria (MDRB). All patients hospitalized for more than 48 h in the ICU were included in this prospective observational study. MDRB were defined as methicillin resistant Staphylococcus aureus, Pseudomonas aeruginosa resistant to ceftazidime or imipenem, Gram-negative bacilli producing extended-spectrum beta-lactamases (ESBL), and all strains of Acinetobacter baumannii and Stenotrophomonas maltophilia. Colonization pressure was daily calculated in the three participating ICUs. Univariate and multivariate analyses were used to determine risk factors for ICU-acquired MDRB. Two hundreds and four (34%) of the 593 included patients acquired an MDRB during their ICU stay. Multivariate analysis identified colonization pressure as an independent risk factor for ICU-acquired MDRB (OR (95% CI) 4.18 (1.03-17.01), p = 0.046). Other independent risk factors for ICU-acquired MDRB were mechanical ventilation (3.08 (1.28-7.38), p = 0.012), and arterial catheter use (OR, 3.04 (1.38-6.68), p = 0.006). ICU-acquired MDRB were associated with increased mortality, duration of mechanical ventilation, and ICU stay. However, ICU-acquired MDRB was not independently associated with ICU-mortality. Colonization pressure is an independent risk factor for acquiring MDRB in the ICU.
authors.affiliation: Critical Care Center, CHU Lille, F-59000, Lille, France.|School of Medicine, University of Lille, F-59000, Lille, France.
authors.forename: J
authors.initials: J
authors.lastname: Masse
authors.affiliation: Critical Care Center, CHU Lille, F-59000, Lille, France.
authors.forename: A
authors.initials: A
authors.lastname: Elkalioubie
authors.affiliation: Dunkerque Hospital, Critical Care Department, 130 Avenue Louis Herbeaux BP 6367, 59140, Dunkerque, France.
authors.forename: C
authors.initials: C
authors.lastname: Blazejewski
authors.affiliation: Critical Care Center, CHU Lille, F-59000, Lille, France.
authors.forename: G
authors.initials: G
authors.lastname: Ledoux
authors.affiliation: Microbiology Department, CHU Lille, F-59000, Lille, France.
authors.forename: F
authors.initials: F
authors.lastname: Wallet
authors.affiliation: Critical Care Center, CHU Lille, F-59000, Lille, France.|School of Medicine, University of Lille, F-59000, Lille, France.
authors.forename: J
authors.initials: J
authors.lastname: Poissy
authors.affiliation: Critical Care Center, CHU Lille, F-59000, Lille, France.
authors.forename: S
authors.initials: S
authors.lastname: Preau
authors.affiliation: Critical Care Center, CHU Lille, F-59000, Lille, France. s-nseir@chru-lille.fr.|School of Medicine, University of Lille, F-59000, Lille, France. s-nseir@chru-lille.fr.
authors.forename: S
authors.identifier: http://orcid.org/0000-0002-7618-0357
authors.initials: S
authors.lastname: Nseir
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012641:Selection, Genetic; D016019:Survival Analysis