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[Clinical significance and risk factors for multidrug resistant Enterobacteriaceae colonization].

ABSTRACT: OBJECTIVE:To identify the main risk factors of rectal colonization by multidrug resistant Enterobacteriaceae (MRE), and their clinical impact. METHODS:An observational, prospective cohort study was carried out, between April 2016 and June 2017, where every Monday of each week rectal samples were taken from all the patients admitted at that moment in the Intensive Care Unit. We performed a descriptive analysis of all the variables collected during the study and a multivariate logistic regression analysis to determine the independent association of carriers of MRE against non-carriers and several possible risk factors. RESULTS:During the study period, rectal samples were collected from 208 patients. Of the 208, 30 were carriers of MRE, with a mean age of 64.3 years and a mean score of APACHE II (Acute Physiology and Chronic Health Evaluation II) of 20.6 points. 70% of the patients with MRE had a positive result in the first rectal sample. The variables that were associated with an increased risk of rectal colonization by EMR in the regression analysis were the administration of antibiotics in the previous month (OR 5.2, 95% CI 1.71-15.79) and post-surgical patients (OR 3.8; IC95% 1.51 - 9.51). Although patients with EMR had more frequent infections by these bacteria, no differences were observed in mortality between the two groups. CONCLUSIONS:Post-surgical patients admitted to the ICU and those who received antibiotic treatment in the previous month have a higher probability of colonization due to MRE. The colonized patients presented more frequent infections by MRE although it was not associated to a higher mortality.

SUBMITTER: Padilla-Serrano A

PROVIDER: S-EPMC6166264 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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[Clinical significance and risk factors for multidrug resistant Enterobacteriaceae colonization].

Padilla-Serrano A A Serrano-Castañeda J J JJ Carranza-González R R García-Bonillo M P MP

Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia 20180504 3

<h4>Objective</h4>To identify the main risk factors of rectal colonization by multidrug resistant Enterobacteriaceae (MRE), and their clinical impact.<h4>Methods</h4>An observational, prospective cohort study was carried out, between April 2016 and June 2017, where every Monday of each week rectal samples were taken from all the patients admitted at that moment in the Intensive Care Unit. We performed a descriptive analysis of all the variables collected during the study and a multivariate logis ...[more]

PMID: 29726670

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Project description:BackgroundThe timing of and risk factors for intestinal colonization with multidrug-resistant Enterobacteriaceae (MDRE) are still poorly understood in areas with high MDRE carriage. We determined the prevalence, timing, and risk factors associated with MDRE intestinal colonization among infants in southern Sri Lanka.MethodsWomen and their newborn children were enrolled within 48 h after delivery in southern Sri Lanka. Rectal swabs were collected from women and infants at enrollment and 4-6 weeks later. Enterobacteriaceae were isolated and identified as MDRE (positive for extended-spectrum β-lactamases or carbapenem resistant) using standard microbiologic procedures. We used exact methods (Fisher's exact and Kruskal-Wallis tests) and multivariable logistic regression to identify sociodemographic and clinical features associated with MDRE intestinal colonization. Whole-genome sequencing was performed on selected MDRE isolates to identify phylogroups and antibiotic resistance-encoding genes were identified with NCBI's AMRfinder tool.ResultsOverall, 199 post-partum women and 199 infants were enrolled; 148/199 (74.4%) women and 151/199 (75.9%) infants were reassessed later in the community. Twenty-four/199 (12.1%) women and 3/199 (1.5%) infants displayed intestinal colonization with MDRE at enrollment, while 26/148 (17.6%) women and 24/151 (15.9%) infants displayed intestinal colonization with MDRE at the reassessment. While there were no risk factors associated with infant colonization at enrollment, multivariable analysis indicated that risk factors for infant colonization at reassessment included mother colonized at enrollment (aOR = 3.62) or reassessment (aOR = 4.44), delivery by Cesarean section (aOR = 2.91), and low birth weight (aOR = 5.39). Of the 20 MDRE isolates from infants that were sequenced, multilocus sequence typing revealed that 6/20 (30%) were clustered on the same branch as MDRE isolates found in the respective mothers. All sequenced isolates for mothers (47) and infants (20) had at least one ESBL-producing gene. Genes encoding fosfomycin resistance were found in 33/47 (70%) of mothers' isolates and 16/20 (80%) of infants' isolates and genes encoding resistance to colistin were found in one (2%) mother's isolate.ConclusionsOur results suggest that a substantial proportion of infants undergo MDRE intestinal colonization within 6 weeks of birth, potentially due to postnatal rather than intranatal transmission.

Project description:BackgroundMicrobiome restitution therapies are being developed to prevent gut pathogen colonization among patients in the intensive care unit (ICU) and in other select populations. If preventive therapies are to be effective, they must be administered prior to pathogen acquisition. The timing and risk factors for early acquisition of gut pathogen colonization (within 72 h) are currently unknown and could be helpful to guide ICU trial design.MethodsThis was a prospective cohort study. Patients in the ICU had deep rectal swabs performed within 4 h of ICU admission and exactly 72 h later. Early gut pathogen colonization was classified as the new presence (based on culture of rectal swabs) of one or more of the following organisms of interest: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant (VRE), and Gram-negative bacteria that showed multidrug resistance (MDR) or third generation Cephalosporin resistance (Ceph-R). Clinical risk factors for early acquisition of gut pathogen colonization were captured using the Acute Physiology and Chronic Health Evaluation IV (APACHE IV) scoring system.FindingsAmong 131 patients who were swabbed at ICU admission and 72 h later, the rates of gut pathogen colonization at ICU admission were 11.4%, 10.6%, 38.6%, and 8.3% for MRSA, VRE, MDR and Ceph-R Gram-negatives respectively. Among the patients who were negative for a given pathogen at ICU admission, the rates of early acquisition of gut pathogen colonization were 7.8% for MRSA (95% CI 3.6 to 14.2%), 7.7% for VRE (95% CI 3.6 to 14.1%), 11.3% for MDR Gram-negatives (95% CI 4.4 to 18.8%), and 4.2% for Ceph-R Gram-negatives (95% CI 1.4 to 9.5%). There were no clinical risk factors which independently predicted early acquisition of gut pathogen colonization.InterpretationEarly gut pathogen colonization was common in the ICU, but our single-center study could not identify any clinical risk factors which were significantly associated with acquisition of gut pathogens.

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[Clinical significance and risk factors for multidrug resistant Enterobacteriaceae colonization].

Publications

[Clinical significance and risk factors for multidrug resistant Enterobacteriaceae colonization].

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