Highlights
- •Mechanical ventilation, surgical procedures and renal substitutive therapy were independent risk factors for bloodstream infection by a multidrug-resistant pathogen.
- •In our cohort, trauma was not a risk factor for bloodstream infection by a multidrug-resistant agent.
- •Klebsiella pneumoniae carrying KPC was the most frequent carbapenem-resistant Gram-negative organism and belonged to a predominant clone, while SCCmec type II MRSA was the most prevalent Gram-positive organism causing BSI in our hospital with circulation of several clones.
Background
Bloodstream infections (BSI) by multidrug-resistant (MDR) organisms are responsible
for significant mortality in critically ill trauma patients. Our objective is to identify
the risk factors for BSI by MDR agents and their resistance mechanisms in a trauma
reference hospital.
Methods
During 18 months, all patients admitted in our Intensive Care Unit (ICU) were enrolled
in this prospective cohort. We included the first episode of BSI by carbapenem-resistant
Gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococcus. Demographic and clinical data were
compared among patients with and without BSI and variables with P < .05 were tested in a multivariate analysis. We performed PCR for identification
of carbapenemase and SCC mec genes and Pulsed-field gel electrophoresis for clonality.
Results
Out of 1,528 patients, 302 (19.8%) were trauma and 66 (4.3%) had a MDR-BSI (19.5%
were trauma). The multivariate analysis showed that mechanical ventilation (OR3.16;
95% CI 1-8; P = .02), hemodialysis (OR3.16; 95% CI 1-5; P = .0003) and surgery (OR1.76; 95% CI 1-3; P = .04) were independent risk factors for MDR-BSI. The most frequent MDR were Klebsiella pneumoniae (n = 26) and MRSA (n = 27). Regarding K pneumoniae strains (n = 24), 20 (83.8%) harbored bla KPC gene and 1 bla NDM. The majority of
KPC isolates belonged to a predominant clone; while the MRSA were polyclonal and SCC
mec type II.
Conclusions
Mechanical ventilation, surgery and hemodialysis were independent risk factors for
MDR-BSI in our cohort, but trauma was not. KPC was the main mechanism of resistance
among carbapenem-resistant K pneumoniae that belonged to a predominant clone which could indicate cross-transmission.
Key Words
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Article Info
Publication History
Published online: October 28, 2021
Footnotes
Funding/support: No specific funding was acquired for the development of these guidelines.
Conflicts of Interest: None to report.
Identification
Copyright
© 2021 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
