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Risk factors for colonization by carbapenemase-producing enterobacteria at admission to a Surgical ICU: A retrospective study.
Enferm Infecc Microbiol Clin. 2017 Jun - Jul; 35(6):333-337.EI

Abstract

INTRODUCTION

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+Show Affiliations

Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain. Electronic address: emilio.maseda@gmail.com.Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain.Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain.Microbiology Dpt., Hospital Universitario La Paz, Madrid, Spain.Microbiology Dpt., Hospital Universitario La Paz, Madrid, Spain.General Medicine Dpt., Hospital Universitario Gregorio Marañón, Madrid, Spain.PRISM-AG, Madrid, Spain.Preventive Medicine Dpt., Hospital Infanta Cristina, Madrid, Spain.PRISM-AG, Madrid, Spain.Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain.

Pub Type(s)

Journal Article
Observational Study

Language

eng spa

PubMed ID

27016135

Citation

Maseda, Emilio, et al. "Risk Factors for Colonization By Carbapenemase-producing Enterobacteria at Admission to a Surgical ICU: a Retrospective Study." Enfermedades Infecciosas Y Microbiologia Clinica, vol. 35, no. 6, 2017, pp. 333-337.
Maseda E, Salgado P, Anillo V, et al. Risk factors for colonization by carbapenemase-producing enterobacteria at admission to a Surgical ICU: A retrospective study. Enferm Infecc Microbiol Clin. 2017;35(6):333-337.
Maseda, E., Salgado, P., Anillo, V., Ruiz-Carrascoso, G., Gómez-Gil, R., Martín-Funke, C., Gimenez, M. J., Granizo, J. J., Aguilar, L., & Gilsanz, F. (2017). Risk factors for colonization by carbapenemase-producing enterobacteria at admission to a Surgical ICU: A retrospective study. Enfermedades Infecciosas Y Microbiologia Clinica, 35(6), 333-337. https://doi.org/10.1016/j.eimc.2016.02.017
Maseda E, et al. Risk Factors for Colonization By Carbapenemase-producing Enterobacteria at Admission to a Surgical ICU: a Retrospective Study. Enferm Infecc Microbiol Clin. 2017 Jun - Jul;35(6):333-337. PubMed PMID: 27016135.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk factors for colonization by carbapenemase-producing enterobacteria at admission to a Surgical ICU: A retrospective study. AU - Maseda,Emilio, AU - Salgado,Patricia, AU - Anillo,Víctor, AU - Ruiz-Carrascoso,Guillermo, AU - Gómez-Gil,Rosa, AU - Martín-Funke,Carmen, AU - Gimenez,Maria-Jose, AU - Granizo,Juan-José, AU - Aguilar,Lorenzo, AU - Gilsanz,Fernando, Y1 - 2016/03/22/ PY - 2015/11/04/received PY - 2016/02/11/revised PY - 2016/02/21/accepted PY - 2016/3/27/pubmed PY - 2018/5/1/medline PY - 2016/3/27/entrez KW - BLEE KW - Carbapenemasas KW - Carbapenemases KW - Carriage KW - ESBL KW - Klebsiella pneumoniae KW - OXA-48 KW - Portadores KW - Surgical ICU KW - Unidad de Cuidados Críticos Quirúrgicos SP - 333 EP - 337 JF - Enfermedades infecciosas y microbiologia clinica JO - Enferm. Infecc. Microbiol. Clin. VL - 35 IS - 6 N2 - INTRODUCTION: 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. SN - 1578-1852 UR - https://www.unboundmedicine.com/medline/citation/27016135/Risk_factors_for_colonization_by_carbapenemase_producing_enterobacteria_at_admission_to_a_Surgical_ICU:_A_retrospective_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0213-005X(16)30002-7 DB - PRIME DP - Unbound Medicine ER -