Cargando…

Association between rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: A one year historical cohort study

OBJECTIVE: Rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) probably precedes infection. We aimed to assess the association between rectal HR-GNR colonization and subsequent HR-GNR infection in clinical patients during a follow-up period of one year in a historical cohort study...

Descripción completa

Detalles Bibliográficos
Autores principales: Souverein, Dennis, Euser, Sjoerd M., Herpers, Bjorn L., Kluytmans, Jan, Rossen, John W. A., Den Boer, Jeroen W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347189/
https://www.ncbi.nlm.nih.gov/pubmed/30682095
http://dx.doi.org/10.1371/journal.pone.0211016
_version_ 1783389893947293696
author Souverein, Dennis
Euser, Sjoerd M.
Herpers, Bjorn L.
Kluytmans, Jan
Rossen, John W. A.
Den Boer, Jeroen W.
author_facet Souverein, Dennis
Euser, Sjoerd M.
Herpers, Bjorn L.
Kluytmans, Jan
Rossen, John W. A.
Den Boer, Jeroen W.
author_sort Souverein, Dennis
collection PubMed
description OBJECTIVE: Rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) probably precedes infection. We aimed to assess the association between rectal HR-GNR colonization and subsequent HR-GNR infection in clinical patients during a follow-up period of one year in a historical cohort study design. METHODS: Rectal HR-GNR colonization was assessed by culturing. Subsequent development of infection was determined by assessing all clinical microbiological culture results extracted from the laboratory information system including clinical data regarding HR-GNR infections. A multivariable logistic regression model was constructed with HR-GNR rectal colonization as independent variable and HR-GNR infection as dependent variable. Gender, age, antibiotic use, historic clinical admission and previous (HR-GNR) infections were included as possible confounders. RESULTS: 1133 patients were included of whom 68 patients (6.1%) were colonized with a HR-GNR. In total 22 patients with HR-GNR infections were detected. Urinary tract infections were most common (n = 14, 63.6%), followed by bloodstream infections (n = 5, 22.7%) and other infections (n = 8, 36.4%). Eight out of 68 HR-GNR colonized patients (11.8%) developed a subsequent HR-GNR infection compared to 14 out of 1065 HR-GNR negative patients (1.3%), resulting in an odds ratio (95% CI) of 7.1 (2.8–18.1) in the multivariable logistic regression analyses. CONCLUSIONS: Rectal colonization with a HR-GNR was a significant risk factor for a subsequent HR-GNR infection. This implies that historical colonization culture results should be considered in the choice of empirical antibiotic therapy to include coverage of the cultured HR-GNR, at least in critically ill patients.
format Online
Article
Text
id pubmed-6347189
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher Public Library of Science
record_format MEDLINE/PubMed
spelling pubmed-63471892019-02-02 Association between rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: A one year historical cohort study Souverein, Dennis Euser, Sjoerd M. Herpers, Bjorn L. Kluytmans, Jan Rossen, John W. A. Den Boer, Jeroen W. PLoS One Research Article OBJECTIVE: Rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) probably precedes infection. We aimed to assess the association between rectal HR-GNR colonization and subsequent HR-GNR infection in clinical patients during a follow-up period of one year in a historical cohort study design. METHODS: Rectal HR-GNR colonization was assessed by culturing. Subsequent development of infection was determined by assessing all clinical microbiological culture results extracted from the laboratory information system including clinical data regarding HR-GNR infections. A multivariable logistic regression model was constructed with HR-GNR rectal colonization as independent variable and HR-GNR infection as dependent variable. Gender, age, antibiotic use, historic clinical admission and previous (HR-GNR) infections were included as possible confounders. RESULTS: 1133 patients were included of whom 68 patients (6.1%) were colonized with a HR-GNR. In total 22 patients with HR-GNR infections were detected. Urinary tract infections were most common (n = 14, 63.6%), followed by bloodstream infections (n = 5, 22.7%) and other infections (n = 8, 36.4%). Eight out of 68 HR-GNR colonized patients (11.8%) developed a subsequent HR-GNR infection compared to 14 out of 1065 HR-GNR negative patients (1.3%), resulting in an odds ratio (95% CI) of 7.1 (2.8–18.1) in the multivariable logistic regression analyses. CONCLUSIONS: Rectal colonization with a HR-GNR was a significant risk factor for a subsequent HR-GNR infection. This implies that historical colonization culture results should be considered in the choice of empirical antibiotic therapy to include coverage of the cultured HR-GNR, at least in critically ill patients. Public Library of Science 2019-01-25 /pmc/articles/PMC6347189/ /pubmed/30682095 http://dx.doi.org/10.1371/journal.pone.0211016 Text en © 2019 Souverein et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Souverein, Dennis
Euser, Sjoerd M.
Herpers, Bjorn L.
Kluytmans, Jan
Rossen, John W. A.
Den Boer, Jeroen W.
Association between rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: A one year historical cohort study
title Association between rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: A one year historical cohort study
title_full Association between rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: A one year historical cohort study
title_fullStr Association between rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: A one year historical cohort study
title_full_unstemmed Association between rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: A one year historical cohort study
title_short Association between rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: A one year historical cohort study
title_sort association between rectal colonization with highly resistant gram-negative rods (hr-gnrs) and subsequent infection with hr-gnrs in clinical patients: a one year historical cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347189/
https://www.ncbi.nlm.nih.gov/pubmed/30682095
http://dx.doi.org/10.1371/journal.pone.0211016
work_keys_str_mv AT souvereindennis associationbetweenrectalcolonizationwithhighlyresistantgramnegativerodshrgnrsandsubsequentinfectionwithhrgnrsinclinicalpatientsaoneyearhistoricalcohortstudy
AT eusersjoerdm associationbetweenrectalcolonizationwithhighlyresistantgramnegativerodshrgnrsandsubsequentinfectionwithhrgnrsinclinicalpatientsaoneyearhistoricalcohortstudy
AT herpersbjornl associationbetweenrectalcolonizationwithhighlyresistantgramnegativerodshrgnrsandsubsequentinfectionwithhrgnrsinclinicalpatientsaoneyearhistoricalcohortstudy
AT kluytmansjan associationbetweenrectalcolonizationwithhighlyresistantgramnegativerodshrgnrsandsubsequentinfectionwithhrgnrsinclinicalpatientsaoneyearhistoricalcohortstudy
AT rossenjohnwa associationbetweenrectalcolonizationwithhighlyresistantgramnegativerodshrgnrsandsubsequentinfectionwithhrgnrsinclinicalpatientsaoneyearhistoricalcohortstudy
AT denboerjeroenw associationbetweenrectalcolonizationwithhighlyresistantgramnegativerodshrgnrsandsubsequentinfectionwithhrgnrsinclinicalpatientsaoneyearhistoricalcohortstudy