A-G Venier1, C Leroyer2, C Slekovec3, D Talon3, X Bertrand3, S Parer4, S Alfandari5, J-M Guerin6, B Megarbane7, C Lawrence8, B Clair9, A Lepape10, M Perraud11, P Cassier11, D Trivier12, A Boyer13, V Dubois14, J Asselineau15, A-M Rogues16, R Thiébaut17. 1. CHU, CCLIN Sud-Ouest, Bordeaux, France; INSERM U657, Université de Bordeaux, Bordeaux, France. Electronic address: anne-gaelle.venier@chu-bordeaux.fr. 2. CHU, Hygiène hospitalière, Bordeaux, France. 3. CHU, Hygiène hospitalière, Besançon, France. 4. CHU, Hygiène hospitalière, Montpellier, France. 5. CH DRon, Réanimation et maladies infectieuses, Tourcoing, France. 6. CHU Lariboisière, AP-HP, Hygiène hospitalière, Paris, France. 7. CHU Lariboisière, AP-HP, Réanimation médicale, Paris, France. 8. CHU Poincaré, AP-HP, Hygiène hospitalière, Garches, France. 9. CHU Poincaré, AP-HP, Réanimation médicale, Garches, France. 10. CHU Lyon Sud, Réanimation médicale, Lyon, France. 11. CHU Lyon Hôpital E. Herriot, Laboratoire d'hygiène, Lyon, France. 12. CH Lens, Hygiène hospitalière, Lens, France. 13. CHU, Réanimation médicale, Bordeaux, France. 14. CHU, Laboratoire de bactériologie, Bordeaux, France; UMR 5234 CNRS, Université de Bordeaux, Bordeaux, France. 15. CHU, Unité de soutien méthodologique à la recherche clinique et épidémiologique, Bordeaux, France. 16. INSERM U657, Université de Bordeaux, Bordeaux, France; CHU, Hygiène hospitalière, Bordeaux, France. 17. CHU, Unité de soutien méthodologique à la recherche clinique et épidémiologique, Bordeaux, France; INSERM, U897 Epidemiologie et Biostatistique, Bordeaux, France; Univ Bordeaux, ISPED, Bordeaux, France.
Abstract
BACKGROUND: Pseudomonas aeruginosa is a major nosocomial pathogen in intensive care units (ICUs); however, endogenous versus exogenous origin of contamination remains unclear. AIM: To identify individual and environmental ICU risk factors for P. aeruginosa acquisition. METHODS: A five-month prospective multicentric study was performed in ten French ICUs. Adult patients hospitalized in ICU for ≥ 24 h were included and screened for P. aeruginosa colonization on admission, weekly and before discharge. P. aeruginosa acquisition was defined by a subsequent colonization or infection if screening swabs on admission were negative. Water samples were obtained weekly on water taps of the ICUs. Data on patient characteristics, invasive devices exposure, antimicrobial therapy, P. aeruginosa water and patient colonization pressures, and ICU characteristics were collected. Hazard ratios (HRs) were estimated using multivariate Cox model. FINDINGS: Among the 1314 patients without P. aeruginosa on admission, 201 (15%) acquired P. aeruginosa during their ICU stay. Individual characteristics significantly associated with P. aeruginosa acquisition were history of previous P. aeruginosa infection or colonization, cumulative duration of mechanical ventilation and cumulative days of antibiotics not active against P. aeruginosa. Environmental risk factors for P. aeruginosa acquisition were cumulative daily ward 'nine equivalents of nursing manpower use score' (NEMS) [hazard ratio (HR): 1.47 for ≥ 30 points; 95% confidence interval (CI): 1.06-2.03] and contaminated tap water in patient's room (HR: 1.76; CI: 1.09-2.84). CONCLUSION: Individual risk factors and environmental factors for which intervention is possible were identified for P. aeruginosa acquisition.
BACKGROUND:Pseudomonas aeruginosa is a major nosocomial pathogen in intensive care units (ICUs); however, endogenous versus exogenous origin of contamination remains unclear. AIM: To identify individual and environmental ICU risk factors for P. aeruginosa acquisition. METHODS: A five-month prospective multicentric study was performed in ten French ICUs. Adult patients hospitalized in ICU for ≥ 24 h were included and screened for P. aeruginosa colonization on admission, weekly and before discharge. P. aeruginosa acquisition was defined by a subsequent colonization or infection if screening swabs on admission were negative. Water samples were obtained weekly on water taps of the ICUs. Data on patient characteristics, invasive devices exposure, antimicrobial therapy, P. aeruginosa water and patient colonization pressures, and ICU characteristics were collected. Hazard ratios (HRs) were estimated using multivariate Cox model. FINDINGS: Among the 1314 patients without P. aeruginosa on admission, 201 (15%) acquired P. aeruginosa during their ICU stay. Individual characteristics significantly associated with P. aeruginosa acquisition were history of previous P. aeruginosa infection or colonization, cumulative duration of mechanical ventilation and cumulative days of antibiotics not active against P. aeruginosa. Environmental risk factors for P. aeruginosa acquisition were cumulative daily ward 'nine equivalents of nursing manpower use score' (NEMS) [hazard ratio (HR): 1.47 for ≥ 30 points; 95% confidence interval (CI): 1.06-2.03] and contaminated tap water in patient's room (HR: 1.76; CI: 1.09-2.84). CONCLUSION: Individual risk factors and environmental factors for which intervention is possible were identified for P. aeruginosa acquisition.
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Authors: Stéphanie Druge; Stéphanie Ruiz; Fanny Vardon-Bounes; Marion Grare; François Labaste; Thierry Seguin; Olivier Fourcade; Vincent Minville; Jean-Marie Conil; Bernard Georges Journal: J Intensive Care Date: 2019-07-19