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Risk factors for bloodstream infection by multidrug-resistant organisms in critically ill patients in a reference trauma hospital

Published:October 28, 2021DOI:https://doi.org/10.1016/j.ajic.2021.10.020

      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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