Predictive factors for sepsis by carbapenem resistant Gram-negative bacilli in adult critical patients in Rio de Janeiro: a case-case-control design in a prospective cohort study

Abstract

Background Studies have investigated risk factors for infections by specific species of carbapenem-resistant Gram-negative bacilli (CR-GNB), but few considered the group of GNB species and most of them were performed in the setting of bacteremia or hospital infection. This study was implemented to identify risk factors for sepsis by CR- and carbapenem-susceptible (CS) GNB in intensive care unit (ICU) patients to improve management strategies for CR-GNB sepsis. Methods We developed a case-case-control study from a prospective cohort of patients with systemic inflammatory response syndrome (SIRS), sepsis-2 or sepsis-3 criteria in which blood and other sample cultures were collected and antimicrobial therapy was instituted, in an adult clinical-surgical ICU, at tertiary public hospital in Rio de Janeiro, from August 2015 through March 2017. Results Among the total of 629 ICU admissions followed by 7797 patient-days, after applying inclusion and exclusion criteria we identified 184 patients who developed recurrent or single hospital-acquired sepsis. More than 90% of all evaluable cases of sepsis and 87% of control group fulfilled the modified sepsis-3 definition. Non-fermenting bacilli and ventilator-associated pneumonia predominated as etiology and source of CR-GNB sepsis. While Enterobacteriaceae and intra-abdominal surgical site plus urinary-tract infections prevailed in CS-GNB than CR-GNB sepsis. Carbapenemase production was estimated in 76% of CR-GNB isolates. Multivariate logistic regression analysis revealed previous infection (mostly hospital-acquired bacterial infection or sepsis) (OR = 4.28; 95% CI 1.77–10.35), mechanical ventilation (OR = 4.21; 95% CI 1.17–15.18), carbapenem use (OR = 3.42; 95% CI 1.37–8.52) and length of hospital stay (OR = 1.03; 95% CI 1.01–1.05) as independent risk factors for sepsis by CR-GNB. While ICU readmission (OR = 6.92; 95% CI 1.72–27.78) and nosocomial diarrhea (OR = 5.32; 95% CI 1.07–26.45) were factors associated with CS-GNB sepsis. Conclusions The investigation of recurrent and not only bacteremic episodes of sepsis was the differential of this study. The results are in agreement with the basic information in the literature. This may help improve management strategies and future studies on sepsis by CR-GNB.

Clinical outcome of nosocomial pneumonia caused by Carbapenem-resistant gram-negative bacteria in critically ill patients: a multicenter retrospective observational study

“…Through nationwide surveillance in Taiwan since 2011, an increased resistance to carbapenem has been demonstrated in A. baumannii , K. pneumoniae, and P. aeruginosa from 69.8 to 75.3%, 10.5 to 44.4% and 17.7 to 22.6%, respectively 23 . Previous studies have demonstrated that risk factors, such as carbapenem consumption, LOS, diabetes mellitus, multiple lobar involvement, and prior exposure to antimicrobial therapy, are associated with the acquisition of CRGNB infection 24 – 27 . Moreover, the mortality rate of nosocomial pneumonia caused by CRGNB is also high.…”

Preventive Nurse Actions and Risk Factors Associated With Health Care Related Infections: A Narrative Review

“…Therefore, the use of mechanical ventilation and the length of time the tube is present constitute the main extrinsic risk factors for the development of respiratory tract infections. 14,40,41,42,21,32,22 As well as the greater risk of infection by resistant bacteria. 42 In addition to the risk factors directed to specific sites, other risk factors stood out as predictors of more frequent infections, such as length of stay in the ICU 14,34,39,17,34,39,17,33,18,20,21,22 , use of invasive devices 44,45,25,30,31,18,19,20,28,46 , advanced age 17,18,19,20,21,22 , comorbidities: diabetes mellitus 14, 47,30,48,49,50 , arterial hypertension 27 , chronic obstructive pulmonary disease 32 and smoking.…”

“…14,40,41,42,21,32,22 As well as the greater risk of infection by resistant bacteria. 42 In addition to the risk factors directed to specific sites, other risk factors stood out as predictors of more frequent infections, such as length of stay in the ICU 14,34,39,17,34,39,17,33,18,20,21,22 , use of invasive devices 44,45,25,30,31,18,19,20,28,46 , advanced age 17,18,19,20,21,22 , comorbidities: diabetes mellitus 14, 47,30,48,49,50 , arterial hypertension 27 , chronic obstructive pulmonary disease 32 and smoking. 51 The identification of risk factors for infection in patients makes it possible to direct interventions with more assertive multidisciplinary approaches to achieve best practices and contribute to reducing the outcomes of HAI indicators 10 .…”

The Threat of Carbapenem-Resistant Gram-Negative Bacteria in Patients with Hematological Malignancies: Unignorable Respiratory Non-Fermentative Bacteria-Derived Bloodstream Infections

“… 4 , 6 , 11 Actively surveillance and infection control measures dramatically decreased CRE colonization thereby reducing mortality. 13–15 Importantly, BSI caused by CRNFB should be a matter of great concern, since limited data suggested that NFB displayed a greater carbapenem resistance rate as well as a higher mortality rate than CRE, 16 , 17 30-day mortality rate up to 45%–100%. 18–20 Our previous data also demonstrated a higher mortality rate of CRNFB BSI in HM patients compared to CRE (44.7% vs 36.0%, respectively).…”