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Clinical Impact of Colonization with Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Admitted for Severe Trauma

Multidrug-resistant (MDR) Gram-negative bacteria (GNB) have raised concerns as common, frequent etiologic agents of nosocomial infections, and patients admitted to intensive care units (ICUs) present the highest risk for colonization and infection. The incidence of colonization and infection in trau...

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Autores principales: Ceccarelli, Giancarlo, Alessandri, Francesco, Moretti, Sonia, Borsetti, Alessandra, Maggiorella, Maria Teresa, Fabris, Silvia, Russo, Alessandro, Ruberto, Franco, De Meo, Daniele, Ciccozzi, Massimo, Mastroianni, Claudio M., Venditti, Mario, Pugliese, Francesco, d’Ettorre, Gabriella
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9695038/
https://www.ncbi.nlm.nih.gov/pubmed/36365046
http://dx.doi.org/10.3390/pathogens11111295
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author Ceccarelli, Giancarlo
Alessandri, Francesco
Moretti, Sonia
Borsetti, Alessandra
Maggiorella, Maria Teresa
Fabris, Silvia
Russo, Alessandro
Ruberto, Franco
De Meo, Daniele
Ciccozzi, Massimo
Mastroianni, Claudio M.
Venditti, Mario
Pugliese, Francesco
d’Ettorre, Gabriella
author_facet Ceccarelli, Giancarlo
Alessandri, Francesco
Moretti, Sonia
Borsetti, Alessandra
Maggiorella, Maria Teresa
Fabris, Silvia
Russo, Alessandro
Ruberto, Franco
De Meo, Daniele
Ciccozzi, Massimo
Mastroianni, Claudio M.
Venditti, Mario
Pugliese, Francesco
d’Ettorre, Gabriella
author_sort Ceccarelli, Giancarlo
collection PubMed
description Multidrug-resistant (MDR) Gram-negative bacteria (GNB) have raised concerns as common, frequent etiologic agents of nosocomial infections, and patients admitted to intensive care units (ICUs) present the highest risk for colonization and infection. The incidence of colonization and infection in trauma patients remains poorly investigated. The aim of this study was to assess the risk factors for Carbapenem-resistant (CR)-GNB colonization and the clinical impact of colonization acquisition in patients with severe trauma admitted to the ICU in a CR-GNB hyperendemic country. This is a retrospective observational study; clinical and laboratory data were extracted from the nosocomial infection surveillance system database. Among 54 severe trauma patients enrolled in the study, 28 patients were colonized by CR-GNB; 7 (12.96%) patients were already colonized at ICU admission; and 21 (38.89%) patients developed a new colonization during their ICU stay. Risk factors for colonization were the length of stay in the ICU (not colonized, 14.81 days ± 9.1 vs. colonized, 38.19 days ± 27.9; p-value = 0.001) and days of mechanical ventilation (not colonized, 8.46 days ± 7.67 vs. colonized, 22.19 days ± 15.09; p-value < 0.001). There was a strong statistical association between previous colonization and subsequent development of infection (OR = 80.6, 95% CI 4.5–1458.6, p-value < 0.001). Factors associated with the risk of infection in colonized patients also included a higher Charlson comorbidity index, a longer length of stay in the ICU, a longer duration of mechanical ventilation, and a longer duration of treatment with carbapenem and vasopressors (not infected vs. infected: 0(0–4) vs. 1(0–3), p = 0.012; 24.82 ± 16.77 vs. 47 ± 28.51, p = 0.016; 13.54 ± 15.84 vs. 31.7 ± 16.22, p = 0.008; 1.09 ± 1.14 vs. 7.82 ± 9.15, p = 0.008). The adoption of MDR-GNB colonization prevention strategies in critically ill patients with severe trauma is required to improve the quality of care and reduce nosocomial infections, length of hospital stay and mortality.
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spelling pubmed-96950382022-11-26 Clinical Impact of Colonization with Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Admitted for Severe Trauma Ceccarelli, Giancarlo Alessandri, Francesco Moretti, Sonia Borsetti, Alessandra Maggiorella, Maria Teresa Fabris, Silvia Russo, Alessandro Ruberto, Franco De Meo, Daniele Ciccozzi, Massimo Mastroianni, Claudio M. Venditti, Mario Pugliese, Francesco d’Ettorre, Gabriella Pathogens Article Multidrug-resistant (MDR) Gram-negative bacteria (GNB) have raised concerns as common, frequent etiologic agents of nosocomial infections, and patients admitted to intensive care units (ICUs) present the highest risk for colonization and infection. The incidence of colonization and infection in trauma patients remains poorly investigated. The aim of this study was to assess the risk factors for Carbapenem-resistant (CR)-GNB colonization and the clinical impact of colonization acquisition in patients with severe trauma admitted to the ICU in a CR-GNB hyperendemic country. This is a retrospective observational study; clinical and laboratory data were extracted from the nosocomial infection surveillance system database. Among 54 severe trauma patients enrolled in the study, 28 patients were colonized by CR-GNB; 7 (12.96%) patients were already colonized at ICU admission; and 21 (38.89%) patients developed a new colonization during their ICU stay. Risk factors for colonization were the length of stay in the ICU (not colonized, 14.81 days ± 9.1 vs. colonized, 38.19 days ± 27.9; p-value = 0.001) and days of mechanical ventilation (not colonized, 8.46 days ± 7.67 vs. colonized, 22.19 days ± 15.09; p-value < 0.001). There was a strong statistical association between previous colonization and subsequent development of infection (OR = 80.6, 95% CI 4.5–1458.6, p-value < 0.001). Factors associated with the risk of infection in colonized patients also included a higher Charlson comorbidity index, a longer length of stay in the ICU, a longer duration of mechanical ventilation, and a longer duration of treatment with carbapenem and vasopressors (not infected vs. infected: 0(0–4) vs. 1(0–3), p = 0.012; 24.82 ± 16.77 vs. 47 ± 28.51, p = 0.016; 13.54 ± 15.84 vs. 31.7 ± 16.22, p = 0.008; 1.09 ± 1.14 vs. 7.82 ± 9.15, p = 0.008). The adoption of MDR-GNB colonization prevention strategies in critically ill patients with severe trauma is required to improve the quality of care and reduce nosocomial infections, length of hospital stay and mortality. MDPI 2022-11-04 /pmc/articles/PMC9695038/ /pubmed/36365046 http://dx.doi.org/10.3390/pathogens11111295 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Ceccarelli, Giancarlo
Alessandri, Francesco
Moretti, Sonia
Borsetti, Alessandra
Maggiorella, Maria Teresa
Fabris, Silvia
Russo, Alessandro
Ruberto, Franco
De Meo, Daniele
Ciccozzi, Massimo
Mastroianni, Claudio M.
Venditti, Mario
Pugliese, Francesco
d’Ettorre, Gabriella
Clinical Impact of Colonization with Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Admitted for Severe Trauma
title Clinical Impact of Colonization with Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Admitted for Severe Trauma
title_full Clinical Impact of Colonization with Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Admitted for Severe Trauma
title_fullStr Clinical Impact of Colonization with Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Admitted for Severe Trauma
title_full_unstemmed Clinical Impact of Colonization with Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Admitted for Severe Trauma
title_short Clinical Impact of Colonization with Carbapenem-Resistant Gram-Negative Bacteria in Critically Ill Patients Admitted for Severe Trauma
title_sort clinical impact of colonization with carbapenem-resistant gram-negative bacteria in critically ill patients admitted for severe trauma
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9695038/
https://www.ncbi.nlm.nih.gov/pubmed/36365046
http://dx.doi.org/10.3390/pathogens11111295
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