Influence of antibiotic pressure on multi-drug resistant Klebsiella pneumoniae colonisation in critically ill patients

被引:38
|
作者
Ruiz, Jesus [1 ]
Gordon, Monica [1 ]
Villarreal, Esther [1 ]
Frasquet, Juan [2 ]
Angeles Sanchez, Maria [3 ]
Martin, Maria [1 ]
Castellanos, Alvaro [3 ]
Ramirez, Paula [3 ]
机构
[1] Hosp Univ & Politecn La Fe, Intens Care Unit, IIS La FE, Valencia, Spain
[2] Hosp Univ & Politecn La Fe, Microbiol Dept, Valencia, Spain
[3] Hosp Univ & Politecn La Fe, Intens Care Unit, Valencia, Spain
关键词
K pneumoniae; Antibiotic; Critcal care; Multidrug resistance; Colonization; SPECTRUM-BETA-LACTAMASE; GRAM-NEGATIVE BACILLI; INTENSIVE-CARE-UNIT; RISK-FACTORS; PSEUDOMONAS-AERUGINOSA; INFECTION; ENTEROBACTERIACEAE; EPIDEMIOLOGY; ACQUISITION; MICROBIOME;
D O I
10.1186/s13756-019-0484-8
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
The aim of this study is to evaluate the risk factors for colonisation by multidrug resistant (MDR) K. pneumoniae in a critical care unit and the relationship between colonisation and the antibiotic pressure exerted by the antimicrobial treatments received by patients. A prospective observational was designed. Patients admitted for more than 48 h to an intensive care unit were included. Samples for surveillance cultures were obtained from all the patients upon admission and once a week. The association between risk factors and colonisation by MDR K. pneumoniae was determined by logistic regression. A Cox regression model was used to evaluate the effect of the use of antimicrobials on the colonisation rate. An ARMIA model was used to investigate the association between the incidence of colonisation by MDR strains and the global consumption of antimicrobials in the unit. One thousand seven hundred twenty-five patients were included, from which 308 (17.9%) were positive for MDR K. pneumoniae. In the multivariate analysis, hospitalisation for longer than 7 days together with respiratory infection and administration of any antibiotic was associated with increased MR K. pneumoniae colonisation. Patients who received antibiotics for more than 48 h were colonised earlier than patients who did not receive antibiotic treatment [HR: 2.16 (95%CI:1.55-3.03)]. The ARIMA model found a significant association between the monthly colonisation rate for MR K. pneumoniae and the consumption of cephalosporins and carbapenems in the previous month. Individual antibiotic administration and the global antibiotic pressure of cephalosporins and carbapenems are associated to an increased colonisation by MDR K. pneumoniae strains.
引用
收藏
页数:7
相关论文
共 50 条
  • [31] COLISTIN MONOTHERAPY VERSUS COLISTIN-PLUS REGIMENS FOR TREATMENT OF MULTI-DRUG RESISTANT NOSOCOMIAL PNEUMONIA IN CRITICALLY ILL PATIENTS
    Eagleson, Nikita
    Doshi, Neha
    Cook, Charles
    Murphy, Claire
    CRITICAL CARE MEDICINE, 2012, 40 (12) : U34 - U34
  • [32] Colistin combination therapy improves microbiologic cure in critically ill patients with multi-drug resistant gram-negative pneumonia
    N. L. Parchem
    K. A. Bauer
    C. H. Cook
    J. E. Mangino
    C. D. Jones
    K. Porter
    C. V. Murphy
    European Journal of Clinical Microbiology & Infectious Diseases, 2016, 35 : 1433 - 1439
  • [33] COMPARISON OF INTRAVENOUS COLISTIN WITH AND WITHOUT AEROSOLIZED COLISTIN FOR MULTI-DRUG RESISTANT GRAM-NEGATIVE PNEUMONIA IN CRITICALLY ILL PATIENTS
    Doshi, Neha
    Mount, Kari
    Cook, Charles
    Stawicki, Stanislaw
    Frazee, Erin
    Personett, Heather
    Schramm, Garrett
    Arnold, Heather
    Murphy, Claire
    CRITICAL CARE MEDICINE, 2012, 40 (12) : U247 - U247
  • [34] Colistin combination therapy improves microbiologic cure in critically ill patients with multi-drug resistant gram-negative pneumonia
    Parchem, N. L.
    Bauer, K. A.
    Cook, C. H.
    Mangino, J. E.
    Jones, C. D.
    Porter, K.
    Murphy, C. V.
    EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 2016, 35 (09) : 1433 - 1439
  • [35] COMPARISON OF INTRAVENOUS COLISTIN WITH AND WITHOUT INHALED COLISTIN FOR MULTI-DRUG RESISTANT GRAM-NEGATIVE PNEUMONIA IN CRITICALLY ILL PATIENTS
    Doshi, Neha
    Mount, Kari
    Frazee, Erin
    Personett, Heather
    Schramm, Garrett
    Murphy, Claire
    CRITICAL CARE MEDICINE, 2010, 38 (12) : U227 - U227
  • [36] Multi-Drug Resistance Bacterial Infections in Critically Ill Patients Admitted with COVID-19
    Pasero, Daniela
    Cossu, Andrea Pasquale
    Terragni, Pierpaolo
    MICROORGANISMS, 2021, 9 (08)
  • [37] PROGNOSTIC FACTORS OF CRITICALLY ILL PATIENTS WITH KLEBSIELLA PNEUMONIAE CARBAPENEMASE-PRODUCING
    Santos, Maria Lucia
    Taminato, Monica
    Ramos, Gabriel
    Delgado, Artur
    Ferreira, Juliana
    Carvalho, Werther
    Monteiro, Ana Cristina
    CRITICAL CARE MEDICINE, 2020, 48
  • [38] Developing an antibiotic effective against multi-drug resistant bacteria
    Steussy, C.
    Stauffacher, C.
    Lipton, M.
    Seleem, M.
    ACTA CRYSTALLOGRAPHICA A-FOUNDATION AND ADVANCES, 2014, 70 : C714 - C714
  • [39] Risk factors for vancomycin-resistant enterococci colonisation in critically ill patients
    da Fonseca Batistao, Deivid William
    Gontijo-Filho, Paulo Pinto
    Conceicao, Natalia
    de Oliveira, Adriana Goncalves
    Ribas, Rosineide Marques
    MEMORIAS DO INSTITUTO OSWALDO CRUZ, 2012, 107 (01): : 57 - 63
  • [40] Adjunctive aerosolized colistin for multi-drug resistant gram-negative pneumonia in the critically ill: a retrospective study
    Neha M Doshi
    Charles H Cook
    Kari L Mount
    Stanislaw P Stawicki
    Erin N Frazee
    Heather A Personett
    Garrett E Schramm
    Heather M Arnold
    Claire V Murphy
    BMC Anesthesiology, 13