Emilio Maseda1, Patricia Salgado2, Víctor Anillo2, Guillermo Ruiz-Carrascoso3, Rosa Gómez-Gil3, Carmen Martín-Funke4, Maria-Jose Gimenez5, Juan-José Granizo6, Lorenzo Aguilar5, Fernando Gilsanz2. 1. Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain. Electronic address: emilio.maseda@gmail.com. 2. Anesthesiology and Surgical Critical Care Dpt., Hospital Universitario La Paz, Madrid, Spain. 3. Microbiology Dpt., Hospital Universitario La Paz, Madrid, Spain. 4. General Medicine Dpt., Hospital Universitario Gregorio Marañón, Madrid, Spain. 5. PRISM-AG, Madrid, Spain. 6. Preventive Medicine Dpt., Hospital Infanta Cristina, Madrid, Spain.
Abstract
INTRODUCTION: In 2011, a hospital-wide outbreak of OXA-48 producing Klebsiella pneumoniae occurred in our hospital, an epidemiological setting of high ESBL-producing K. pneumoniae rates. This study identifies risk factors for colonization with carbapenemase-producing enterobacteria (CPE) at Surgical Intensive Care Unit (SICU) admission. METHODS: A 2-year retrospective study was performed in all patients admitted to the SICU that following routine had a rectal swab collected upon admission. RESULTS: Of 254 patients admitted, 41 (16.1%) harbored CPE (five showing two carbapenemase-producing isolates). Most frequent carbapenemase-producing isolates and carbapenemases were K. pneumoniae (39/46, 84.8%) and OXA-48 (31/46; 76.1%), respectively. Carriers significantly had higher rates of chronic renal disease, previous digestive/biliary endoscopy, hospitalization, ICU/SICU admission, intraabdominal surgery, and antibiotic intake, as well as higher median values of clinical scores (SOFA, SAPS II and APACHE II). In the multivariate analysis (R2=0.309, p<0.001), CPE carriage was associated with prior administration of 3rd-4th generation cephalosporins (OR=27.96, 95%CI=6.88, 113.58, p<0.001), β-lactam/β-lactamase inhibitor (OR=11.71, 95%CI=4.51, 30.43, p<0.001), abdominal surgery (OR=6.33, 95%CI=2.12, 18.89, p=0.001), and prior digestive/biliary endoscopy (OR=3.88, 95%CI=1.56, 9.67, p=0.004). CONCLUSIONS: A strong association between production of ESBLs and carriage of CPE (mainly OXA-48 producing K. pneumoniae) was found. According to the model, the co-selection of β-lactamases by previous exposure to broad-spectrum cephalosporins and β-lactam/β-lactamase inhibitors (with lower relative risk), abdominal surgery and prior digestive/biliary endoscopy were factors associated with CPE carriage.
INTRODUCTION: In 2011, a hospital-wide outbreak of OXA-48 producing Klebsiella pneumoniae occurred in our hospital, an epidemiological setting of high ESBL-producing K. pneumoniae rates. This study identifies risk factors for colonization with carbapenemase-producing enterobacteria (CPE) at Surgical Intensive Care Unit (SICU) admission. METHODS: A 2-year retrospective study was performed in all patients admitted to the SICU that following routine had a rectal swab collected upon admission. RESULTS: Of 254 patients admitted, 41 (16.1%) harbored CPE (five showing two carbapenemase-producing isolates). Most frequent carbapenemase-producing isolates and carbapenemases were K. pneumoniae (39/46, 84.8%) and OXA-48 (31/46; 76.1%), respectively. Carriers significantly had higher rates of chronic renal disease, previous digestive/biliary endoscopy, hospitalization, ICU/SICU admission, intraabdominal surgery, and antibiotic intake, as well as higher median values of clinical scores (SOFA, SAPS II and APACHE II). In the multivariate analysis (R2=0.309, p<0.001), CPE carriage was associated with prior administration of 3rd-4th generation cephalosporins (OR=27.96, 95%CI=6.88, 113.58, p<0.001), β-lactam/β-lactamase inhibitor (OR=11.71, 95%CI=4.51, 30.43, p<0.001), abdominal surgery (OR=6.33, 95%CI=2.12, 18.89, p=0.001), and prior digestive/biliary endoscopy (OR=3.88, 95%CI=1.56, 9.67, p=0.004). CONCLUSIONS: A strong association between production of ESBLs and carriage of CPE (mainly OXA-48 producing K. pneumoniae) was found. According to the model, the co-selection of β-lactamases by previous exposure to broad-spectrum cephalosporins and β-lactam/β-lactamase inhibitors (with lower relative risk), abdominal surgery and prior digestive/biliary endoscopy were factors associated with CPE carriage.
Authors: Benoit Pilmis; Vincent Jullien; Alexis Tabah; Jean-Ralph Zahar; Christian Brun-Buisson Journal: Ann Intensive Care Date: 2017-11-10 Impact factor: 6.925
Authors: Mario Rivera-Izquierdo; Antonio Jesús Láinez-Ramos-Bossini; Carlos Rivera-Izquierdo; Jairo López-Gómez; Nicolás Francisco Fernández-Martínez; Pablo Redruello-Guerrero; Luis Miguel Martín-delosReyes; Virginia Martínez-Ruiz; Elena Moreno-Roldán; Eladio Jiménez-Mejías Journal: Antibiotics (Basel) Date: 2021-01-18
Authors: Martin Agud; Ines de Medrano; Ana Mendez-Echevarria; Talia Sainz; Federico Román; Guillermo Ruiz Carrascoso; Luis Escosa-Garcia; Clara Molina Amores; Francisco José Climent; Aroa Rodríguez; Marta Garcia-Fernandez de Villalta; Cristina Calvo Journal: Sci Rep Date: 2022-05-04 Impact factor: 4.996