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

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art_CAMPOS_Risk_factors_for_bloodstream_infection_by_multidrugresistant_organisms_2022.PDF (774.17 KB)
Citações na Scopus
7
Tipo de produção
article
Data de publicação
2022
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
MOSBY-ELSEVIER
Autores
CAMPOS, Luciana Rodrigues Pires de
Citação
AMERICAN JOURNAL OF INFECTION CONTROL, v.50, n.6, p.673-679, 2022
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
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.
Palavras-chave
Nosocomial infection, Antimicrobial resistance, Bacteremia, Injury
URI
https://observatorio.fm.usp.br/handle/OPI/48419
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MIP
Artigos e Materiais de Revistas Científicas - LIM/49
Artigos e Materiais de Revistas Científicas - ODS/03