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Vol. 47. Issue 11.
Pages 629-637 (November 2023)
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Vol. 47. Issue 11.
Pages 629-637 (November 2023)
Original article
Preventive isolation criteria for the detection of multidrug-resistant bacteria in patients admitted to the Intensive Care Unit: A multicenter study within the Zero Resistance program
Criterios de aislamiento preventivo para la detección de portadores de bacterias multirresistentes en pacientes ingresados en UCI: estudio multicéntrico dentro del programa Resistencia Zero
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Sulamita Carvalho-Bruggera,b,
Corresponding author
, Mar Miralbés Tornera,b, Gabriel Jiménez Jiméneza,b, Oihane Badalloc, Francisco Álvares Lermad, Javier Trujillanoa,b, Franciso Xavier Nuvials Casalse, Mercedes Palomara
a Department of Intensive Care Medicine, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain
b Institut de Recerca Biomèdica de Lleida, Lleida, Spain
c Department of Intensive Care Medicine, Hospital Universitario de Burgos, Burgos, Spain
d Department of Intensive Care Medicine, Hospital del Mar, Barcelona, Spain
e Department of Intensive Care Medicine, Hospital Universitario Vall d’Hebrón, Barcelona, Spain
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Figures (2)
Tables (5)
Table 1. Differential characteristics of the 9 hospitals included in the study (n = 2252).
Table 2. Differential characteristics according to isolated multidrug-resistant bacteria (n = 283).
Table 3. Demographic characteristics of the patients admitted to the ICU (n = 2175), according to detection of multidrug-resistant bacteria (MRB) carriers.
Table 4. Multivariate logistic regression analysis of the different preventive isolation factors included in the ZR project.
Table 5. Multivariate logistic regression model of factors influencing the presence of MRB.
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Abstract
Objective

To verify the validity of a checklist of risk factors (RFs) proposed by the Spanish “Zero Resistance” project (ZR) in the detection of multidrug-resistant bacteria (MRB), and to identify other possible RFs for colonization and infection by MRB on admission to the Intensive Care Unit (ICU).

Design

A prospective cohort study, conducted in 2016.

Setting

Multicenter study, patients requiring admission to adult ICUs that applied the ZR protocol and accepted the invitation for participating in the study.

Patients or participants

Consecutive sample of patients admitted to the ICU and who underwent surveillance (nasal, pharyngeal, axillary and rectal) or clinical cultures.

Interventions

Analysis of the RFs of the ZR project, in addition to other comorbidities, included in the ENVIN registry. A univariate and multivariate analysis was performed, with binary logistic regression methodology (significance considered for p < 0.05). Sensitivity and specificity analyses were performed for each of the selected factors.

Main variables of interest

Carrier of MRB on admission to the ICU, RFs (previous MRB colonization/infection, hospital admission in the previous 3 months, antibiotic use in the past month, institutionalization, dialysis, and other chronic conditions) and comorbidities.

Results

A total of 2270 patients from 9 Spanish ICUs were included. We identified MRB in 288 (12.6% of the total patients admitted). In turn, 193 (68.2%) had some RF (OR 4.6, 95%CI: 3.5–6.0). All 6 RFs from the checklist reached statistical significance in the univariate analysis (sensitivity 66%, specificity 79%). Immunosuppression, antibiotic use on admission to the ICU and the male gender were additional RFs for MRB. MRB were isolated in 87 patients without RF (31.8%).

Conclusions

Patients with at least one RF had an increased risk of being carriers of MRB. However, almost 32% of the MRB were isolated in patients without RFs. Other comorbidities such as immunosuppression, antibiotic use on admission to the ICU and the male gender could be considered as additional RFs.

Keywords:
Multidrug resistance
Antibiotic resistance
Risk factors
Zero Resistance
Resumen
Objetivo

Conocer el rendimiento de los criterios de aislamiento preventivo del programa Resistencia Zero (RZ) e identificar factores que pudieran mejorar su rendimiento.

Diseño

Estudio de cohorte prospectivo, multicéntrico.

Ámbito

Unidades de cuidados críticos que aplicaban el protocolo RZ y que aceptaron la invitación al estudio.

Pacientes o participantes

Pacientes a los que se les realizaron cultivos de vigilancia (nasal, faríngeo, axilar y rectal) y/o diagnósticos al ingreso en UCI.

Intervenciones

Análisis de los factores de riesgo (FR) RZ y otras variables del registro ENVIN. Se realizó un estudio univariable y multivariable con metodología de regresión logística binaria (significación con p < 0.05). Se realizó análisis de sensibilidad y especificidad para cada uno de los factores seleccionados.

Variables de interés principales

Portador de bacteria multirresistente (BMR) al ingreso en UCI, FR (antecedente de colonización/infección por BMR, ingreso hospitalario en los 3 meses previos, uso de antibiótico el mes previo, estar institucionalizado, diálisis y otras condiciones crónicas) y comorbilidades.

Resultados

Participaron 2252 pacientes de 9 UCIs españolas. Fueron identificados BMR en 283 (12,6%). 193 (68,2%) presentaban algún FR (OR 4,6, IC 95% 3,5–6,0). Todos los FR RZ alcanzaron significación estadística (sensibilidad 66%, especificidad 79%), siendo el antecedente de BMR el factor con más peso. Inmunodepresión, tratamiento antibiótico al ingreso y sexo masculino son FR adicionales para BMR. Se aislaron BMR en 87 (31,8%) sin FR.

Conclusiones

La presencia de al menos un FR aumenta el riesgo de ser portador de BMR, siendo el más importante el antecedente de colonización/infección por BMR. Casi el 32% de las BMR se encuentran en pacientes sin FR. Inmunodepresión, tratamiento antibiótico al ingreso y sexo masculino podrían ser añadidos al algoritmo de FR para decidir el aislamiento preventivo.

Palabras clave:
Bacterias multirresistentes
Resistencia antibiótica
Factores de riesgo
Resistencia Zero

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