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BMC Infectious Diseases

, 12:375

Bacterial and fungal diseases

Abstract

BackgroundThere is a lack of consensus regarding the definition of risk factors for healthcare-associated infection HCAI. The purpose of this study was to identify additional risk factors for HCAI, which are not included in the current definition of HCAI, associated with infection by multidrug-resistant MDR pathogens, in all hospitalized infected patients from the community.

MethodsThis 1-year prospective cohort study included all patients with infection admitted to a large, tertiary care, university hospital. Risk factors not included in the HCAI definition, and independently associated with MDR pathogen infection, namely MDR Gram-negative MDR-GN and ESKAPE microorganisms vancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus, extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species, carbapenem-hydrolyzing Klebsiella pneumonia and MDR Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species, were identified by logistic regression among patients admitted from the community either with community-acquired or HCAI.

ResultsThere were 1035 patients with infection, 718 from the community. Of these, 439 61% had microbiologic documentation; 123 were MDR 28%. Among MDR: 104 85% had MDR-GN and 41 33% had an ESKAPE infection. Independent risk factors associated with MDR and MDR-GN infection were: age adjusted odds ratio OR = 1.7 and 1.5, p = 0.001 and p = 0.009, respectively, and hospitalization in the previous year between 4 and 12 months previously adjusted OR = 2.0 and 1,7, p = 0.008 and p = 0.048, respectively. Infection by pathogens from the ESKAPE group was independently associated with previous antibiotic therapy adjusted OR = 7.2, p < 0.001 and a Karnofsky index <70 adjusted OR = 3.7, p = 0.003. Patients with infection by MDR, MDR-GN and pathogens from the ESKAPE group had significantly higher rates of inadequate antibiotic therapy than those without 46% vs 7%, 44% vs 10%, 61% vs 15%, respectively, p < 0.001.

ConclusionsThis study suggests that the inclusion of additional risk factors in the current definition of HCAI for MDR pathogen infection, namely age >60 years, Karnofsky index <70, hospitalization in the previous year, and previous antibiotic therapy, may be clinically beneficial for early diagnosis, which may decrease the rate of inadequate antibiotic therapy among these patients.

KeywordsHealthcare-associated infections Multidrug resistant pathogens infection Multidrug resistant gram negatives infection ESKAPE microorganisms’ infection Independent risk factors Inadequate antibiotic therapy AbbreviationsCAICommunity-acquired infection

HCAIHealthcare-associated infection

HAIHospital-acquired infection

MDRMultidrug-resistant

MDR-GNMultidrug-resistant Gram-negative

ESKAPEVancomycin-resistant Enterococcus faecium, methicillin-resistant Staphylococcus aureus MRSA, extended-spectrum beta-lactamase ESBL-producing E. coli and Klebsiella species, carbapenem-hydrolyzing Klebsiella pneumonia and MDR Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species

CDCCenter for Disease Control

ICUIntensive Care Unit

MRSAMethicillin-resistant Staphylococcus aureus

ESBLExtended-spectrum beta-lactamase

MICMinimum inhibitory concentration

SAPSSimplified acute physiological score

IQRInter-quartile range

SDStandard deviation

OROdds ratio

CI95%95% confidence interval.

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Autor: Teresa Cardoso - Orquídea Ribeiro - Irene César Aragão - Altamiro Costa-Pereira - António Eugénio Sarmento

Fuente: https://link.springer.com/







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