OBJECTIVE: To determine the relationship between immunosuppression and intensive care unit (ICU)-acquired multidrug-resistant (MDR) bacteria. DESIGN: Retrospective case-control study based on prospectively collected data. SETTING: A 30-bed medical and surgical ICU. PATIENTS: All patients hospitalized >48 hrs in the ICU were eligible during a 2-yr period. INTERVENTIONS: Immunosuppression was defined as active solid or hematologic malignancy, leucopenia, or chronic immunosuppressive treatment. MDR bacteria were defined as methicillin-resistant Staphylococcus aureus, ceftazidime- or imipenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and extending spectrum beta-lactamase producing Gram-negative bacilli. MDR bacteria screening (nasal, anal, and axilla swabs and tracheal aspirate in intubated patients) was performed at ICU admission and weekly. Only MDR bacteria isolated >48 hrs after ICU admission were taken into account; duplicates were excluded. Isolation measures were applied in all patients at ICU admission, in patients with MDR bacteria, and in patients with immunosuppression. Immunosuppressed patients (cases) were matched (1:1) with immunocompetent patients (controls) according to all the following criteria: age +/-5 yrs, Simplified Acute Physiology Score II +/-5, duration of ICU stay +/-3 days, and category of admission (medical/surgical). Risk factors for ICU-acquired MDR bacteria were determined using univariate and multivariate analyses. MEASUREMENTS AND MAIN RESULTS: Of 1,065 eligible patients, nine patients were excluded for absence of MDR bacteria screening at ICU admission. One hundred thirty-three (12%) patients were immunosuppressed, and 128 (96%) of them were successfully matched. Mean time between ICU admission and first ICU-acquired MDR bacteria was 12 +/- 9 days. Incidence of MDR bacteria was significantly higher in cases than in controls (22 vs. 12 MDR bacteria/1000 ICU days, p = .004). However, immunosuppression was not independently associated with ICU-acquired MDR bacteria.Multivariate analysis identified prior antibiotic treatment and antibiotic treatment in the ICU as risk factors for ICU-acquired MDR bacteria (odds ratio [95% confidence interval] = 1.9 [1-3.6], p = .003; 11 [1.4-83], p = .02; respectively). CONCLUSIONS: Immunosuppression is not independently associated with ICU-acquired MDR bacteria. However, infection control measures used in our ICU may have influenced this result.
OBJECTIVE: To determine the relationship between immunosuppression and intensive care unit (ICU)-acquired multidrug-resistant (MDR) bacteria. DESIGN: Retrospective case-control study based on prospectively collected data. SETTING: A 30-bed medical and surgical ICU. PATIENTS: All patients hospitalized >48 hrs in the ICU were eligible during a 2-yr period. INTERVENTIONS: Immunosuppression was defined as active solid or hematologic malignancy, leucopenia, or chronic immunosuppressive treatment. MDR bacteria were defined as methicillin-resistant Staphylococcus aureus, ceftazidime- or imipenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii, Stenotrophomonas maltophilia, and extending spectrum beta-lactamase producing Gram-negative bacilli. MDR bacteria screening (nasal, anal, and axilla swabs and tracheal aspirate in intubated patients) was performed at ICU admission and weekly. Only MDR bacteria isolated >48 hrs after ICU admission were taken into account; duplicates were excluded. Isolation measures were applied in all patients at ICU admission, in patients with MDR bacteria, and in patients with immunosuppression. Immunosuppressed patients (cases) were matched (1:1) with immunocompetent patients (controls) according to all the following criteria: age +/-5 yrs, Simplified Acute Physiology Score II +/-5, duration of ICU stay +/-3 days, and category of admission (medical/surgical). Risk factors for ICU-acquired MDR bacteria were determined using univariate and multivariate analyses. MEASUREMENTS AND MAIN RESULTS: Of 1,065 eligible patients, nine patients were excluded for absence of MDR bacteria screening at ICU admission. One hundred thirty-three (12%) patients were immunosuppressed, and 128 (96%) of them were successfully matched. Mean time between ICU admission and first ICU-acquired MDR bacteria was 12 +/- 9 days. Incidence of MDR bacteria was significantly higher in cases than in controls (22 vs. 12 MDR bacteria/1000 ICU days, p = .004). However, immunosuppression was not independently associated with ICU-acquired MDR bacteria.Multivariate analysis identified prior antibiotic treatment and antibiotic treatment in the ICU as risk factors for ICU-acquired MDR bacteria (odds ratio [95% confidence interval] = 1.9 [1-3.6], p = .003; 11 [1.4-83], p = .02; respectively). CONCLUSIONS: Immunosuppression is not independently associated with ICU-acquired MDR bacteria. However, infection control measures used in our ICU may have influenced this result.
Authors: Sameer J Patel; André P Oliveira; Juyan Julia Zhou; Luis Alba; E Yoko Furuya; Scott A Weisenberg; Haomiao Jia; Sarah A Clock; Christine J Kubin; Stephen G Jenkins; Audrey N Schuetz; Maryam Behta; Phyllis Della-Latta; Susan Whittier; Kyu Rhee; Lisa Saiman Journal: Am J Infect Control Date: 2014-04-13 Impact factor: 2.918
Authors: José Garnacho Montero; Francisco Álvarez Lerma; Paula Ramírez Galleymore; Mercedes Palomar Martínez; Luis Álvarez Rocha; Fernando Barcenilla Gaite; Joaquín Álvarez Rodríguez; Mercedes Catalán González; Inmaculada Fernández Moreno; Jesús Rodríguez Baño; José Campos; Jesús Ma Aranaz Andrés; Yolanda Agra Varela; Carolina Rodríguez Gay; Miguel Sánchez García Journal: Crit Care Date: 2015-03-16 Impact factor: 9.097
Authors: Orestis Ioannidis; Loukiani Kitsikosta; Dimitris Tatsis; Ioannis Skandalos; Aggeliki Cheva; Aikaterini Gkioti; Ioannis Varnalidis; Savvas Symeonidis; Natalia Antigoni Savvala; Styliani Parpoudi; George K Paraskevas; Manousos George Pramateftakis; Efstathios Kotidis; Ioannis Mantzoros; Konstantinos George Tsalis Journal: Front Surg Date: 2017-07-10