Original article
Multi-drug resistant organism infections in a medical ICU: Association to clinical features and impact upon outcome
Infecciones por organismos multirresistentes en una UCI médica: asociación con las características clínicas e impacto en los resultados
a Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, 425 East 61st ST, 4th Floor, New York, NY 10065, USA
b Department of 1st Critical Care, Evangelismos Hospital, National and Kapodistrian University of Athens, 45-47 Ipsilantou 10676, Athens, Greece
c Department of Biostatistics, Winthrop University Hospital, 222 Station Plaza North, Suite 301, Mineola, NY 11501, USA
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Magira, S. Islam, M.S. Niederman" "autores" => array:3 [ 0 => array:3 [ "nombre" => "E.E." "apellidos" => "Magira" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 1 => array:3 [ "nombre" => "S." "apellidos" => "Islam" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:4 [ "nombre" => "M.S." "apellidos" => "Niederman" "email" => array:1 [ 0 => "msn9004@med.cornell.edu" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, 425 East 61st ST, 4th Floor, New York, NY 10065, USA" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of 1st Critical Care, Evangelismos Hospital, National and Kapodistrian University of Athens, 45-47 Ipsilantou 10676, Athens, Greece" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Biostatistics, Winthrop University Hospital, 222 Station Plaza North, Suite 301, Mineola, NY 11501, USA" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infecciones por organismos multirresistentes en una UCI médica: asociación con las características clínicas e impacto en los resultados" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Infections remain one of the most serious concerns in the critical care setting, where multidrug resistant organism (MDRO) outbreaks can jeopardize the chances for effective therapy. An organism is considered multi-drug resistant when in vitro drug – susceptibility testing shows resistance to one or more classes of antimicrobial agents recommended as first line therapy.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a> Multidrug resistance has been demonstrated for a variety of organisms that are more common in ICUs than in other hospital wards, and the risk of infection increases with duration of hospitalization.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">2–4</span></a> The primary goal of this study was to compare the epidemiological and the clinical characteristics, of patients with and without MDRO in a medical ICU (MICU). The secondary goal is to determine the accuracy of the empiric antibiotic selection and the outcomes associated with MDRO infection. We also evaluated the timing of appropriate empiric therapy, and its impact on outcomes.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Prior studies have shown that critically ill patients harboring MDROs have an increased mortality,<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">5–7</span></a> primarily because resistance is often associated with inappropriate empiric therapy. However, other reports<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">8,9</span></a> have suggested that it is unclear whether using appropriate empiric antimicrobial therapy improves mortality in these patients. When MDROs are common, empiric antibiotic selection for at risk patients should be based on known susceptibility patterns of likely microorganisms, while reliance on culture data cannot correct initial errors of empiric therapy. Thus, defining clinical factors associated with MDRO infection can potentially lead to less inappropriate empiric therapy and improved outcomes.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Study design and setting</span><p id="par0015" class="elsevierStylePara elsevierViewall">This retrospective case–control study was conducted in the medical intensive care unit (MICU) at Winthrop University Hospital, a 600-bed tertiary care university hospital, between January 1, 2010 and May 31, 2010. Only active and symptomatic infections, receiving antimicrobial treatment, were included. MDRO positive patients had organisms resistant to one or more classes of antimicrobial agents recommended as first line therapy and were identified from: blood, sputum, urine or tissue cultures, collected at the time of suspected infection. Included organisms were: <span class="elsevierStyleItalic">Acinetobacter baumannii</span>, <span class="elsevierStyleItalic">Escherichia coli</span>, <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>, <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>, <span class="elsevierStyleItalic">Proteus mirabilis</span>, <span class="elsevierStyleItalic">Morganella morganii</span> and <span class="elsevierStyleItalic">Serratia</span> spp.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Other organisms identified, were <span class="elsevierStyleItalic">vancomycin-resistant enterococcus</span> spp. (VRE) and methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> (MRSA) bacteria. Susceptibilities to all antimicrobial agents were determined and interpreted according to criteria of the Clinical and Laboratory Standards Institute (CLSI) by disk diffusion susceptibility.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a> Intermediate susceptibility was considered as resistance, based on CLSI standards<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">10</span></a> and because this approach has been used in other MDRO studies in the ICU.<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">11–13</span></a> Only MDROs isolated more than 48<span class="elsevierStyleHsp" style=""></span>h after MICU admission and within 15 days after MICU discharge were considered, and duplicates were excluded. All patients had cultures obtained at the time of suspected infection, but if cultures were negative, they were considered MDRO negative.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Controls were patients with infection requiring antimicrobial therapy, but with no MDROs in any type of cultures. We included culture negative patients in the control group because culture-negative sepsis is common in the United States, with 49% of hospitalized patients with sepsis being culture-negative.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> Patients could be included more than once, if there were different admissions for each infection. The study was approved by the Institutional Review Board of the Winthrop University Hospital. Patient consent was waived because data were collected and analyzed anonymously and retrospectively from patient records. All research data obtained were de-identified, handled, stored and shared with confidentiality.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Demographic data</span><p id="par0030" class="elsevierStylePara elsevierViewall">Patient characteristics including, age, gender, race, body mass index, past medical and/or surgical history, comorbid illness and clinical course (total length of stay, and MICU length of stay) were recorded. Antimicrobial drug exposures were assessed during hospital admission and until discharge. Duration (days of use) of antimicrobial exposure, central venous catheter, and bladder catheter were also analyzed. Days of antibiotics, ventilation and hospitalization were further separated, into days prior and after the diagnosis of infection. The recorded outcomes were: mortality, discharge to home, or to a nursing home/long term facility.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Definitions</span><p id="par0035" class="elsevierStylePara elsevierViewall">The CDC definitions were used for infections at different anatomic sites.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a> The definition of MDRO used was adopted from the CDC recommendations for the management of MDR organisms in healthcare settings that defines MDR organisms as bacteria that are resistant to one or more classes of antimicrobial agents recommended as first line therapy.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Vancomycin-resistant <span class="elsevierStyleItalic">Enterococcus</span> spp. (VRE) was defined as the <span class="elsevierStyleItalic">Enterococcus faecium/facaelis species</span> that were resistant to vancomycin by standard susceptibility testing methods or by results from any FDA-approved test for VRE detection from specific specimen sources. Methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> (MRSA) was defined as <span class="elsevierStyleItalic">Staphylococcus aureus</span> cultured from any specimen that tested oxacillin-resistant, cefoxitin-resistant, or methicillin-resistant by standard susceptibility testing methods.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Antimicrobial classes were: penicillins (oxacillin), third-generation cephalosporins (ceftazidime, cefotaxime, ceftriaxone), fourth-generation cephalosporins (cefepime), carbapenems (meropenem, etrapenem), anti-pseudomonal penicillins (piperacillin-tazobactam), aminoglycosides (amikacin, gentamicin), monobactams (aztreonam), glycopeptide (vancomycin) quinolones (levofloxacin, moxifloxacin), and glycylcyclines (tigecycline). Susceptibility to colistin was not considered.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The distinction between colonization and infection when the site of infection was the urinary tract or the lungs, was made by evaluating clinical criteria such as the presence of fever and the adequacy of organ perfusion. All included patients and controls met criteria for infection.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Immunosuppression was defined, as active solid or hematologic malignancy, leukopenia (absolute neutrophil count <1500<span class="elsevierStyleHsp" style=""></span>cells/μl blood), chronic immunosuppressive treatment, prior radiation and use of corticosteroids at a dose of least 10<span class="elsevierStyleHsp" style=""></span>mg/d for 15 days.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Prior hospitalization, prior antimicrobial use and prior surgical history were defined as a hospital stay, antimicrobial administration and undergoing major surgery respectively, within 3 months before the index hospitalization.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Liver dysfunction was considered present in any patient with of a bilirubin concentration over 2.0<span class="elsevierStyleHsp" style=""></span>mg/dl or with liver cirrhosis, while renal insufficiency was defined in a patient with a creatinine level above 2.0<span class="elsevierStyleHsp" style=""></span>mg/dl or requirement for dialysis. Cardiovascular failure was defined when inotropic drugs were required. Respiratory dysfunction was defined as inadequate gas exchange requiring endotracheal intubation and mechanical ventilation.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Previous history of hyperlipidemia was defined in a patient who was diagnosed with an abnormal level of lipids in the blood and was currently being treated. Previous history of hypothyrodism was defined in a patient who was diagnosed with hypothyroidism and was receiving therapy.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Initial empiric antibiotic treatment was defined as appropriate if the antibiotic prescribed within 24<span class="elsevierStyleHsp" style=""></span>h of obtaining cultures matched the in vitro susceptibility of the presumed etiologic pathogen, in a patient with a positive culture at the time of infection. The doses used were in accordance with current standards. For example, in patients with normal renal function, we prescribed ertapenem 1<span class="elsevierStyleHsp" style=""></span>g q24h, meropenem 1<span class="elsevierStyleHsp" style=""></span>g q8h, ceftriaxone 2<span class="elsevierStyleHsp" style=""></span>g q24h, cefotaxime 1<span class="elsevierStyleHsp" style=""></span>g q8h, ceftazidime 1<span class="elsevierStyleHsp" style=""></span>g q8h, cefepime 1<span class="elsevierStyleHsp" style=""></span>g q6h, aztreonam 2<span class="elsevierStyleHsp" style=""></span>g q8h, vancomycin loading dose 25–30<span class="elsevierStyleHsp" style=""></span>mg/kg, followed by 15<span class="elsevierStyleHsp" style=""></span>mg/kg q12h, linezolid 600<span class="elsevierStyleHsp" style=""></span>mg q12h, levofloxacin 750<span class="elsevierStyleHsp" style=""></span>mg q24h, piperacillin-tazobactam 4.5<span class="elsevierStyleHsp" style=""></span>g q8h, gentamicin 7<span class="elsevierStyleHsp" style=""></span>mg/kg, daptomycin 6–8<span class="elsevierStyleHsp" style=""></span>mg/kg IV q24h, tigecycline 100<span class="elsevierStyleHsp" style=""></span>mg IV loading dose, followed by 50<span class="elsevierStyleHsp" style=""></span>mg q12h. By 2010, the CLSI approved new breakpoints for meropenem, imipenem, and doripenem that define susceptibility as a MIC of ≤1<span class="elsevierStyleHsp" style=""></span>μg/ml and resistance as ≥4<span class="elsevierStyleHsp" style=""></span>μg/ml.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">Continuous variables were tested for normality using histograms and Kolmogorov–Smirnov test. If the data were markedly non-normally distributed, they are presented as medians (interquartile range) and categorical data are presented as percentages. Fisher's exact test was used to compare MDRO (positive vs. negative) for binary variables and Wilcoxon rank-sum test for continuous variables. We used all variables that were significant in univariate logistic regression at <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 in the multiple logistic regression model, with a stepwise selection method to find independent predictors of MDRO. Risk was assessed using odds ratios. All calculations were performed utilizing SAS 9.2 (SAS Institute, Cary, NC) for Windows and results were considered statistically significant when <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Patient characteristics</span><p id="par0090" class="elsevierStylePara elsevierViewall">Three hundred and thirteen (313) patients were included in this study. Demographic and clinical characteristics comparing cases and controls are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Although Coagulase-negative Staphylococci (CoNS) can cause true bacteraemia, repeated blood cultures (from a total of 9 subjects) did not isolate CoNS with either the same antibiogram or isolated another pathogen. Therefore these CoNs isolates were considered as a contaminant and not a pathogen. MDRO were found in 127 patients (41.7%), while 177 (58.2%) did not have MDRO (control population) present in cultures. Of the 177 control patients, a non-MDRO pathogen was present in 65 and cultures were negative in 112. Among the MDRO positive and negative patients, infection may have been incubating at the time of hospital admission in 21 (16%) and in 9 patients (12%) respectively, although all infections were diagnosed after 48<span class="elsevierStyleHsp" style=""></span>h in the ICU, and thus met the criteria for nosocomial infection. Interestingly all these patients had healthcare exposure risk factors [history of prior hospitalization and one or two comorbidities (COPD, diabetes)] and thus were similar to HAIs in terms of various comorbid conditions, source of infection, pathogens and mortality rate and therefore we considered them as HAIs.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The MDRO patients had a median age of 75 years vs. 69 years in controls (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.06). There were no statistically significant differences between the two groups with respect to gender and body mass index. The comorbidities were similar, except that more MDRO positive patients had immunosuppression (60.0% vs 41.2%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.001), prior antimicrobial use (12.6% vs 6.2%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.06) and a history of prior hospitalization (33.1% vs 19.2%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.007).</p><p id="par0100" class="elsevierStylePara elsevierViewall">Among the 127 patients with MDRO infection, 38 (29.9%) had septic shock,. Septic shock was present in 35 (19.7%) of the 177 patients with non-MDRO infection. All other patients had active infection with sepsis. Of the 127 MDRO positive patients, previous colonization with the same MDRO was not identified, although routine surveillance cultures were not collected.</p><p id="par0105" class="elsevierStylePara elsevierViewall">In those with MDRO infection, the site of infection was: the urinary tract in 55%, the lung in 35% and other sites (abdomen, skin and soft tissues) in 10%. For those with non-MDRO infection, the site of infection was: the urinary tract in 32%, the lung in 38%, and other sites in 30%.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The identity and frequency of the pathogens are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, with methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>, <span class="elsevierStyleItalic">Enterococcus faecium</span>, <span class="elsevierStyleItalic">Acinetobacter baumannii</span>, <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>, <span class="elsevierStyleItalic">Escherichia coli</span> and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> being the most common. After univariate analysis (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), the clinical factors associated with MDRO were: infection and cardiac disease as a cause of admission, total days in hospital, days in MICU, days on the ventilator, days with a central venous catheter, tracheostomy, prior hospitalization, prior antibiotic use (before hospitalization), immunosuppression, past history of hyperlipidemia, use of vasopressors, past history of surgery and white blood cell count >10,000/mm<span class="elsevierStyleSup">3</span> on admission.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Multivariable analysis of clinical features associated with MDRO</span><p id="par0115" class="elsevierStylePara elsevierViewall">The multivariate analysis included all variables with a univariate <span class="elsevierStyleItalic">p</span>-value of <0.05 (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>), and the only clinical features significantly associated with MDRO were: infection as a cause of admission (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.3), total days in hospital (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.04) total days of ventilation (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.013, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.07), immunosuppression (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.01, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.04), past history of hyperlipidemia (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.008, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.2), past surgical history (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.033, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.82), age (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.032, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.02) and white race (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.025, OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.44). Days of ventilation and days in hospital were further separated, into days before and after the onset of infection.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Relationship of MDROs to hospital days, ventilator days, prior and after the diagnosis of infection</span><p id="par0120" class="elsevierStylePara elsevierViewall">The median time for acquiring an MDRO infection while in the hospital was 8 days (range of 1–48 days). Each additional hospital day increased the risk of having an MDRO by about 5%.</p><p id="par0125" class="elsevierStylePara elsevierViewall">Days of hospitalization (the day of hospital admission was calendar day 1) were separated, into days prior and days after the diagnosis of infection. Both groups spent a similar number of days in the hospital prior to infection, but the MDRO positive patients spent a greater median number of days after infection than the MDRO negative patients. The median number of days in hospital after the diagnosis of infection was 13 and 10 days, respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.006) for the MDRO positive and negative patients (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Culture negative control patients were not included in this analysis.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">In the analysis of days on ventilation prior and after the diagnosis of infection we observed that more days on ventilation (prior to infection) were present for MDRO+ versus MDRO− patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.009). Additionally MDRO patients spent more median days on ventilation after infection than MDRO negative patients (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.054). Culture negative control patients were not included in this analysis.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Relationship of MDRO to antibiotic use, prior and after the diagnosis of the infection</span><p id="par0135" class="elsevierStylePara elsevierViewall">MDRO positive patients had a greater median number of antibiotic days before infection and after infection, compared to MDRO negative patients. Among MDRO positive and negative patients the median number of days of antibiotics prescribed prior to the infection was 2 and 0 days respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.004) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). After the diagnosis of the infection among the MDRO positive and negative patients the median number of days of antibiotics prescribed was 8 and 6 days respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.009) (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).</p><p id="par0140" class="elsevierStylePara elsevierViewall">Multivariable analysis did not identify any specific antibiotic as independently associated with MDROs.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Appropriateness of initial antibiotic therapy and the impact of MDRO on outcomes</span><p id="par0145" class="elsevierStylePara elsevierViewall">Appropriate empiric antibiotic therapy (matching in vitro susceptibility to the isolated pathogen) was administrated in 105 out of 127 (82.6%) of MDRO positive cases. 72/105 (68.5%) patients received appropriate therapy within 24<span class="elsevierStyleHsp" style=""></span>h of the onset of infection. Among MDRO negative patients with an identified pathogen, 60/65 received antibiotic therapy, which was appropriate in 54/60. The use of appropriate therapy was not associated with reduced mortality in either the MDRO positive or MDRO negative patients.</p><p id="par0150" class="elsevierStylePara elsevierViewall">No statistically significant difference in 28-day ICU mortality rate was observed between MDRO positive and MDRO negative patients (20% vs 12.4%, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.07). In addition, there was no difference in the percent of patients discharged to home, nursing home, hospice or other long term care facilities (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">Discussion</span><p id="par0155" class="elsevierStylePara elsevierViewall">In this study, clinical features associated with MDRO pathogen infection in the ICU were identified, along with the impact of resistance and appropriate initial antimicrobial therapy on outcomes, including mortality. Only infection as a cause of admission to the hospital, total days in hospital, total days of mechanical ventilation, immunosuppression, past surgical history, past history of hyperlipidemia and age were independently associated with resistance. Moreover, white race was independently associated with protection against the MDRO infection.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Total days on ventilation may have been either a risk factor for, or a consequence of MDRO infection. To clarify this issue, we separated ventilator days into those prior and after the onset of infection. Those patients with MDRO had a greater median number of ventilator days after the onset of infection than those without MDRO. We also found, as did others, that one of the most important determinants of MDRO pathogen emergence was the duration of mechanical ventilation prior to the onset of pneumonia.<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">Previous investigators have shown that prolonged hospitalization can predispose patients to infection with antibiotic-resistant bacteria,<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a> but they have not analyzed the relationship between hospital stay and antibiotic resistance in the same way as in this study. In the present study, each day of hospitalization increased the risk of MDRO by 5%, and the onset of MDRO infection was at a median of 8 days. However, we also found that MDRO infection itself prolonged hospitalization. Patients with MDRO spent a similar number of hospital days before infection and those without MDRO, but more hospital days after the onset of infection than those without MDRO.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Similarly, we examined the relationship of exposure to antibiotics to MDRO infection. While those with MDRO infection received more total antibiotics than those without, we also found that antibiotics were used more often and for a longer time both before and after the onset of ICU infection in those with MDROs compared to those without. Thus, antibiotic use was not only a necessary response to infection with resistant organisms, but also a risk factor for their acquisition.</p><p id="par0175" class="elsevierStylePara elsevierViewall">No statistically significant difference was observed between MDRO positive and control patients for mortality. Although this is in contrast to many prior studies, in most instances, the mechanism for increased mortality was the frequent use of inappropriate empiric therapy. In our study, the use of appropriate empiric antibiotic therapy (matching in vitro susceptibility for the isolated pathogen) was common and most patients received the antibiotics within 24<span class="elsevierStyleHsp" style=""></span>h of the onset of the infection. It seems possible that if resistance is anticipated and initial therapy is timely, and correct, then mortality may not be increased by the presence of MDRO pathogens.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Infection as an indication for admission was more frequently observed in the MDRO patients than in the control patients. Infection on ICU admission has been identified as a predisposing factor for <span class="elsevierStyleItalic">Acinetobacter baumannii</span> acquisition in a number of reports.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">19–21</span></a> The presence of an infection on ICU admission was also an independent risk factor for <span class="elsevierStyleItalic">Acinetobacter baumannii</span> bacteremia.<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a> Colonization or infection by MDRO and/or carbapenem-resistant <span class="elsevierStyleItalic">Acinetobacter baumannii</span> was also found in patients who had prior infection in a study from Brazil.<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a> It is likely that the presence of an infection at the time of admission led the physicians to use broad-spectrum antibiotics, which favored the selection of multidrug-resistant microorganisms as the cause of their next, nosocomial, infection. In a retrospective case–control study, Nseir et al. found that immune suppression was not associated with ICU-acquired MDRO bacteria,<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a> while we found it to be an independently associated risk factor. However, the concept of immune suppression is broad, and includes a heterogeneous population, only some of whom are at high risk.<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a></p><p id="par0185" class="elsevierStylePara elsevierViewall">Our data also showed that in the multivariable analysis, past history of hyperlipidemia was associated with MDRO, and all these individuals were receiving cholesterol lowering therapy. An older agent, neomycin, can increase the risk of resistant flora,<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">26</span></a> but statins may have an immune modulating effect, although their impact on bacteriology has not been carefully examined.<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">27,28</span></a> Multivariable analysis also identified that for every one year increase in age, holding other independent predictors constant, the odds of having MDRO increased by 2%. Age above or equal to 65 years was identified by other investigators as an independent risk factor for harboring MDR-GNB at hospital admission.<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">29</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Most of our MDRO patients had undergone surgery in the previous 6 months (56%). Extended-spectrum beta-lactamases (ESBL) – producing bacteria have been shown to be more frequent in patients with a past history of urogenital surgery history.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a> Prior surgery may also indirectly reflect the effect of antibiotic use. Moreover white race was independently associated with protection against the MDROs, although the validity of this finding is uncertain because the majority of our patients were white. However, previous studies have shown that VRE and MRSA are more common in African Americans than in white patients, and that ESBL positive <span class="elsevierStyleItalic">E. coli</span> are more common in Asian speaking patients than in others.<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">31–33</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">Several limitations of this study merit discussion. In our control group many patients were culture negative and thus we could not be certain that they did not have an MDRO infection, however, we did not include any patients who had no cultures collected. Culture negative sepsis is a well-documented problem, and thus we believed that it was important to include these patients.<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">4,14</span></a> In addition, in these patients, we could not determine if they received appropriate therapy, so they were excluded from any analysis of this factor. One other limitation is that, our sample size lacked the power to show a difference in mortality, so the observed lack of difference may have not have been present in a larger study. It is also possible that the lack of significant difference in mortality between the two groups may be partially explained by differences in infection sites. The high frequency of urinary tract infections may reflect the time period of this study, and its having been conducted prior to a change in the hospital policy for daily assessment of the need for bladder catheters. Finally this study is limited by its retrospective design and it was conducted at a single center in a single ICU over a few months and thus may not be fully representative of other hospitals. Moreover the study was performed seven years ago and this may affect the applicability and the validity of our findings, particularly with regard to the site of infection, as stated above.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Conclusion</span><p id="par0200" class="elsevierStylePara elsevierViewall">Our findings suggest that, knowing the risk factors for MDRO pathogens could lead to early appropriate antimicrobial administration, which could prevent mortality from these organisms. In our hospital, we did not withhold broad spectrum agents as empiric therapy in patients with clinical features associated with MDRO infection, and thus our rate of appropriate empiric therapy was high, which could explain the lack excess mortality in patients infected with MDRO pathogens.</p><p id="par0205" class="elsevierStylePara elsevierViewall">Our findings are unique because of our breakdown of days before and after the onset of infection. With this approach, we found that, prolonged antibiotic therapy before infection is a risk factor for MDRO acquisition, reinforcing the need for judicious antimicrobial stewardship. However, after the onset of infection, patients with MDROs required a longer duration of antibiotic therapy than those without these organisms. In addition, we found that patients with MDRO pathogens had a longer duration of ventilation, both prior and after the onset of infection than MDRO negative patients. In addition, days of ventilation was an independent risk factor associated with MDRO infection. Interestingly, we found that although those with MDRO pathogens had a longer length of stay than those without, most of the prolonged length of stay was the consequence of this infection and not the cause of the emergence of MDRO pathogens.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Funding</span><p id="par0210" class="elsevierStylePara elsevierViewall">This study was supported by internal institutional funds. No external funds were utilized for this study.</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Authors’ contributions</span><p id="par0215" class="elsevierStylePara elsevierViewall">EEM and MSN contributed to the design of the study. EEM executed the study, collected the data and wrote the first draft. SI performed the statistical analysis. MSN conceived the study, participated in its design and in analyzing data, provided overall supervision of this project and revised the article for important intellectual content. All authors read and approved the final manuscript.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflict of interest</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres1022429" "titulo" => "Abstract" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Setting" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec980576" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xpalclavsec980575" "titulo" => "Abbreviations" ] 3 => array:3 [ "identificador" => "xres1022430" "titulo" => "Resumen" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0045" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0050" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0055" "titulo" => "Pacientes" ] 4 => array:2 [ "identificador" => "abst0060" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0065" "titulo" => "Resultados" ] 6 => array:2 [ "identificador" => "abst0070" "titulo" => "Conclusión" ] ] ] 4 => array:2 [ "identificador" => "xpalclavsec980577" "titulo" => "Palabras clave" ] 5 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 6 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design and setting" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Demographic data" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Definitions" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 7 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Patient characteristics" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Multivariable analysis of clinical features associated with MDRO" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Relationship of MDROs to hospital days, ventilator days, prior and after the diagnosis of infection" ] 3 => array:2 [ "identificador" => "sec0055" "titulo" => "Relationship of MDRO to antibiotic use, prior and after the diagnosis of the infection" ] 4 => array:2 [ "identificador" => "sec0060" "titulo" => "Appropriateness of initial antibiotic therapy and the impact of MDRO on outcomes" ] ] ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0070" "titulo" => "Conclusion" ] 10 => array:2 [ "identificador" => "sec0075" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0080" "titulo" => "Authors’ contributions" ] 12 => array:2 [ "identificador" => "sec0085" "titulo" => "Conflict of interest" ] 13 => array:2 [ "identificador" => "xack345243" "titulo" => "Acknowledgement" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-05-01" "fechaAceptado" => "2017-07-24" "PalabrasClave" => array:2 [ "en" => array:2 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec980576" "palabras" => array:5 [ 0 => "Multi-drug resistant organisms" 1 => "Antibiotics" 2 => "Clinical features" 3 => "ICU mortality" 4 => "Appropriate therapy" ] ] 1 => array:4 [ "clase" => "abr" "titulo" => "Abbreviations" "identificador" => "xpalclavsec980575" "palabras" => array:12 [ 0 => "MDRO" 1 => "VRE" 2 => "MRSA" 3 => "CLSI" 4 => "SD" 5 => "WBC" 6 => "COPD" 7 => "CDC" 8 => "ESBLs" 9 => "CI" 10 => "ROC" 11 => "AUC" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec980577" "palabras" => array:5 [ 0 => "Organismos multirresistentes" 1 => "Antibióticos" 2 => "Características clínicas" 3 => "Mortalidad en UCI" 4 => "Tratamiento adecuado" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To define clinical features associated with Intensive Care Unit (ICU) infections caused by multi-drug resistant organisms (MDRO) and their impact on patient outcome.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Design</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A single-center, retrospective case–control study was carried out between January 2010 and May 2010.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Setting</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A medical ICU (MICU) in the United States.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Patients</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The study included a total of 127 MDRO-positive patients and 186 MDRO-negative patients.</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Interventions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">No interventions were carried out.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Results</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Out of a total of 313 patients, MDROs were present in 127 (41.7%). Based on the multivariate analysis, only infection as a cause of admission [OR 3.3 (1.9–5.8)]), total days of ventilation [OR 1.07 (1.01–1.12)], total days in hospital [OR 1.04 (1.01–1.07)], immunosuppression [OR 2.04 (1.2–3.5)], a history of hyperlipidemia [OR 2.2 (1.2–3.8)], surgical history [OR 1.82 (1.05–3.14)] and age [OR 1.02 (1.00–1.04)] were identified as clinical factors independently associated to MDROs, while the Caucasian race was negatively associated to MDROs. The distribution of days on ventilation, days in hospital and days of antibiotic treatment prior to infection differed between the MDRO-positive and MDRO-negative groups. The MDRO-positive patients showed a greater median number of days in hospital and days of antibiotic treatment before infection, with a greater median number of days in hospital, days of antibiotic treatment and days of ventilation after infection, compared to the MDRO-negative patients. The mortality rate was not significantly different between the two groups. Appropriate empirical antibiotic therapy was prescribed in 82% of the MDRO-positive cases – such treatment being started within 24<span class="elsevierStyleHsp" style=""></span>h after onset of the infection in 68.5% of the cases.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Defining clinical factors associated with MDRO infections and administering timely and appropriate empirical antibiotic therapy may help reduce the mortality associated with these infections. In our hospital we did not withhold broad spectrum drugs as empirical therapy in patients with clinical features associated to MDRO infection. Our rate of appropriate empirical therapy was therefore high, which could explain the absence of excessive mortality in patients infected with MDROs.</p></span>" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Design" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Setting" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Patients" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Interventions" ] 5 => array:2 [ "identificador" => "abst0030" "titulo" => "Results" ] 6 => array:2 [ "identificador" => "abst0035" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Objetivo</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Definir las características clínicas asociadas a las infecciones en la unidad de cuidados intensivos causadas por organismos multirresistentes (OMR) y el impacto asociado en los resultados del paciente.</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Diseño</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se llevó a cabo un estudio de casos y controles, retrospectivo y unicéntrico entre enero de 2010 y mayo de 2010.</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Ámbito</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Unidad de cuidados intensivos médica en Estados Unidos.</p></span> <span id="abst0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Pacientes</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Se incluyó en el estudio a un total de 127 pacientes con infección positiva para OMR y a 186 pacientes con infección negativa para OMR.</p></span> <span id="abst0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Intervenciones</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">No se ha llevado a cabo ninguna intervención.</p></span> <span id="abst0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">De un total de 313 pacientes se observaron OMR en 127 (41,7%). En un análisis multivariable únicamente se identificaron la infección como causa del ingreso (OR: 3,3 [1,9-5,8]), el total de días con ventilación (OR 1,07 [1,01-1,12]), el total de días de hospitalización (OR 1,04 [1,01-1,07]), la inmunosupresión (OR 2,04 [1,2-3,5]), los antecedentes de hiperlipidemia (OR 2,2 [1,2-3,8]), los antecedentes quirúrgicos (OR 1,82 [1,05-3,14]) y la edad (OR 1,02 [1,002-1,04]) como factores clínicos asociados de manera independiente con los OMR, mientras que dicha asociación fue negativa en el caso de la raza blanca. La distribución de los días de ventilación, los días de ingreso hospitalario y los días de tratamiento con antibióticos antes de la infección fueron diferentes entre los grupos positivo para OMR y negativo para OMR. El grupo de pacientes positivos para OMR presentó una mayor mediana del número de días de hospitalización y de tratamiento con antibióticos antes de la infección, con una mayor mediana del número de días de hospitalización, de tratamiento con antibióticos y de ventilación tras la infección frente a los pacientes del grupo negativo para OMR. La diferencia en la tasa de mortalidad entre ambos grupos no fue estadísticamente significativa. Se prescribió un tratamiento empírico adecuado en el 82% de los casos positivos para OMR, un tratamiento que se inició en el plazo de las 24<span class="elsevierStyleHsp" style=""></span>horas siguientes a la manifestación de la infección en el 68,5% de los casos.</p></span> <span id="abst0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusión</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La definición de los factores clínicos asociados a las infecciones por OMR y la administración de un tratamiento antibiótico empírico adecuado y de manera oportuna puede ayudar a reducir la mortalidad asociada a estas infecciones. En nuestro hospital no restringimos los fármacos de amplio espectro como tratamiento empírico en pacientes con características clínicas asociadas con la infección por OMR. Por este motivo, nuestra tasa de administración de un tratamiento empírico adecuado ha sido elevada, lo que podría explicar la ausencia de una mortalidad excesiva elevada en el caso de los pacientes infectados con OMR.</p></span>" "secciones" => array:7 [ 0 => array:2 [ "identificador" => "abst0040" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0045" "titulo" => "Diseño" ] 2 => array:2 [ "identificador" => "abst0050" "titulo" => "Ámbito" ] 3 => array:2 [ "identificador" => "abst0055" "titulo" => "Pacientes" ] 4 => array:2 [ "identificador" => "abst0060" "titulo" => "Intervenciones" ] 5 => array:2 [ "identificador" => "abst0065" "titulo" => "Resultados" ] 6 => array:2 [ "identificador" => "abst0070" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Continuous variables are presented as median (1srt quartile–3rd quartile) as they were not normally distributed and categorical variables are presented as <span class="elsevierStyleItalic">n</span> (%).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " colspan="4" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Patient characteristics by group</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MDRO positive (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>127) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MDRO negative (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>177) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-value<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Demographics</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Age (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75 (64–81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 (55–82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.060 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Body mass index</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.1 (23–33.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26.5 (23.9–30.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.819 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Gender (male vs female)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 (46.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93 (52.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.352 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Race (white vs non-white)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 (74.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">149 (84.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.057 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Cause of admission</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Infection (hospital-acquired)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 (60.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">52 (29.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Respiratory</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (11.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (15.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.312 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cardiac</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (22.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">68 (38.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Comorbidities</span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">(i) Pre- infection variables</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 (41.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 (31.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.089 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Immunosuppression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77 (60.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73 (41.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Prior antimicrobial use \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (12.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (6.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.066 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Prior hospitalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (33.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (19.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.007 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Past surgical history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 (55.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">76 (42.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.028 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Cigarette smoking (active) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 (18.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">42 (23.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.328 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>IV toxic drug use \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.643 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Ethanol abuse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (5.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (10.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.145 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Past history of hyperlipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 (44.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54 (30.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.016 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Past history of hypothyroidism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14 (11.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (15.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.244 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>(<span class="elsevierStyleItalic">ii)Post-infection variables</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Proton-pump inhibitors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 (66.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 (55.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.058 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Sedation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (26.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41 (23.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.502 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Vasopressors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38 (29.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (19.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.040 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Tracheostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (15.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>WBC above 10,000/mm<span class="elsevierStyleSup">3</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 (52.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (37.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Days in hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (13–30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (10–19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Days in MICU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (4–14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (4–8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Days on ventilator \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0–10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Days with central venous catheter \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (0–13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0–5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Days on antibiotics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20 (10–37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (2–16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Respiratory dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">35 (27.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36 (20.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.169 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Liver dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (4.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Kidney dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30 (23.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (18.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.317 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Cardiac dysfunction \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 (74.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118 (66.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.130 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Culture positive within 15 days after MICU discharge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (1–15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1(0–7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleBold">Microorganisms</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (17.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (4.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Acinetobacter baumannii</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (13.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Klebsiella pneumonia</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (29.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (5.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enterococcus spp.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43 (33.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (6.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Escherichia coli</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (21.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 (8.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Methicillin-resistant Staphylococcus aureus</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 (39.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 (6.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Proteus mirabilis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19 (15.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Serratia spp.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (3.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.030 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Morganella spp.</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (4.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0.0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Others</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25 (19.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (15.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.444 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Outcome</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Died \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">26 (20.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (12.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.079 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Nursing home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 (5.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (3.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.400 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67 (52.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">117 (66.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.024 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Hospice \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (3.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (2.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.498 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>LTCF \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (17.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">28 (15.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.755 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737562.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">p</span>-values are from Wilcoxon rank-sum test for continuous variables and Fisher's exact Test for categorical variables.</p> <p class="elsevierStyleNotepara" id="npar0010">WBC, white blood cells; IV, intra venous; MICU, medical intensive care unit; LTCF, long term care facility.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Demographic and clinical characteristics comparisons for case and controls patients. Pre-infection and post-infection variables are also shown.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Variable \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Unadjusted<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a></th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Adjusted<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">b</span></a></th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Race (white</span> vs. <span class="elsevierStyleItalic">non-white)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.56 (0.32–0.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.044 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.44 (0.22–0.90) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.025 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">Age (years)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.02 (1.003–1.03) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.02 (1.002–1.04) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.032 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Cause of admission</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Infection (hospital-acquired) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7 (2.29–5.99) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.3 (1.9–5.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cardiac \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.47 (0.28–0.79) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Comorbidities</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Immunosuppression \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.19 (1.38–3.49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.04 (1.2–3.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prior hospitalization \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.08 (1.23–3.52) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Past surgical history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.69 (1.06–2.67) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.026 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.82 (1.05–3.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.033 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Prior history of hyperlipidemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.80 (1.12–2.89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.2 (1.2–3.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vasopressors \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.80 (1.05–3.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.031 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tracheostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7.61 (2.5–23.00) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>WBC above 10,000/mm<span class="elsevierStyleSup">3</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.78 (1.12–2.82) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.015 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days in hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.06 (1.04–1.09) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.04 (1.01–1.07) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days in MICU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.08 (1.04–1.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days on ventilator \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.10 (1.05–1.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.07 (1.01–1.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.013 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days with CVC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.07 (1.04–1.10) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Antibiotics</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days on Vancomycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.11 (1.06–1.17) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days on Linezolid \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.20 (1.08–1.33) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days on Daptomycin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.18 (1.005–1.38) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.044 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days on Metronidazole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.11 (1.02–1.22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.021 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days on Piperacillin-tazobactam \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.15 (1.05–1.26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.002 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days on Meropenem \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.11 (1.06–1.16) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days on Tigecycline \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.51 (1.19–1.91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Days on Mycafugin \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.29 (1.04–1.60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.022 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Discharge to</span></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Home \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.57 (0.36–0.91) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737560.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Simple logistic regression models</p>" ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Multiple logistic regression model. The model was a good fit with area under the curve (AUC) 0.80.</p> <p class="elsevierStyleNotepara" id="npar0025">OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Odds Ratio; CI<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>Confidence Interval.</p> <p class="elsevierStyleNotepara" id="npar0030">WBC, white blood cells; CVC, central venous catheter; MICU, medical intensive care unit; LTCF, long term care facility.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Unadjusted and adjusted analysis for clinical features associated with MDRO pathogens. Multivariable model revealed eight clinical and demographics factors that were independently associated with MDRO after removing co-linear variables.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col">Variable<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">MDRO+ \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">MDRO− \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col"><span class="elsevierStyleItalic">p</span>-value<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median (q1, q3) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Median (q1, q3) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Days in hospital_prior_to the infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 (0, 12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (1, 8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.994 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Days in_hospital_after the infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (8, 22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (5, 15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Days of antibiotics prior to the infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0, 9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0, 2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Days of antibiotics after the infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 (5, 14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (1, 12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Days on_ventilation_prior_to the infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0, 2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0, 0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.009 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Days on ventilation after the_infection \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (0, 8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0, 4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.054 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737561.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0035">All of the variables were non-normally distributed.</p>" ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0040"><span class="elsevierStyleItalic">p</span> values are from non parametric Wilcoxon Rank-Sum test as the variables did not follow Gaussian distribution.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Pre- and post-infection comparisons between MDRO positive and negative group.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0170" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Healthcare Infection Control Practices Advisory Committee Management of multidrug-resistant organisms in healthcare settings, 2006" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 8 | 16 |
| 2024 October | 68 | 59 | 127 |
| 2024 September | 79 | 40 | 119 |
| 2024 August | 118 | 56 | 174 |
| 2024 July | 82 | 30 | 112 |
| 2024 June | 103 | 51 | 154 |
| 2024 May | 55 | 40 | 95 |
| 2024 April | 75 | 36 | 111 |
| 2024 March | 52 | 37 | 89 |
| 2024 February | 44 | 48 | 92 |
| 2024 January | 29 | 38 | 67 |
| 2023 December | 24 | 33 | 57 |
| 2023 November | 30 | 40 | 70 |
| 2023 October | 30 | 67 | 97 |
| 2023 September | 44 | 68 | 112 |
| 2023 August | 30 | 16 | 46 |
| 2023 July | 38 | 38 | 76 |
| 2023 June | 47 | 23 | 70 |
| 2023 May | 52 | 46 | 98 |
| 2023 April | 45 | 23 | 68 |
| 2023 March | 86 | 35 | 121 |
| 2023 February | 74 | 38 | 112 |
| 2023 January | 42 | 36 | 78 |
| 2022 December | 91 | 36 | 127 |
| 2022 November | 72 | 42 | 114 |
| 2022 October | 69 | 53 | 122 |
| 2022 September | 62 | 49 | 111 |
| 2022 August | 49 | 50 | 99 |
| 2022 July | 46 | 51 | 97 |
| 2022 June | 47 | 25 | 72 |
| 2022 May | 52 | 41 | 93 |
| 2022 April | 32 | 34 | 66 |
| 2022 March | 46 | 52 | 98 |
| 2022 February | 45 | 48 | 93 |
| 2022 January | 29 | 32 | 61 |
| 2021 December | 47 | 55 | 102 |
| 2021 November | 40 | 39 | 79 |
| 2021 October | 47 | 80 | 127 |
| 2021 September | 45 | 41 | 86 |
| 2021 August | 44 | 58 | 102 |
| 2021 July | 22 | 29 | 51 |
| 2021 June | 38 | 32 | 70 |
| 2021 May | 44 | 52 | 96 |
| 2021 April | 111 | 151 | 262 |
| 2021 March | 79 | 33 | 112 |
| 2021 February | 63 | 45 | 108 |
| 2021 January | 60 | 48 | 108 |
| 2020 December | 63 | 37 | 100 |
| 2020 November | 29 | 27 | 56 |
| 2020 October | 28 | 38 | 66 |
| 2020 September | 49 | 27 | 76 |
| 2020 August | 35 | 21 | 56 |
| 2020 July | 20 | 22 | 42 |
| 2020 June | 30 | 21 | 51 |
| 2020 May | 33 | 29 | 62 |
| 2020 April | 38 | 11 | 49 |
| 2020 March | 33 | 27 | 60 |
| 2020 February | 65 | 59 | 124 |
| 2020 January | 29 | 29 | 58 |
| 2019 December | 18 | 23 | 41 |
| 2019 November | 19 | 24 | 43 |
| 2019 October | 20 | 22 | 42 |
| 2019 September | 16 | 27 | 43 |
| 2019 August | 25 | 14 | 39 |
| 2019 July | 19 | 18 | 37 |
| 2019 June | 9 | 17 | 26 |
| 2019 May | 31 | 29 | 60 |
| 2019 April | 16 | 9 | 25 |
| 2019 March | 19 | 21 | 40 |
| 2019 February | 22 | 23 | 45 |
| 2019 January | 23 | 25 | 48 |
| 2018 December | 13 | 46 | 59 |
| 2018 November | 29 | 78 | 107 |
| 2018 October | 20 | 16 | 36 |
| 2018 June | 0 | 1 | 1 |
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