Background
Methods
Study population and data collection
-
Patients >18 years old admitted to ICU.
-
Taken in charge by at least two shifts of nurses during their stay in our ICU.
Hygiene and isolation protocol
Microbiological analysis
Statistical analysis
Results
Settings and characteristics of the population
Variable | All patients
n = 470 | No ESBL colonization
n = 408 | ESBL colonization
n = 62 |
p
|
---|---|---|---|---|
Age (years) | 66.0 [54.0, 77.0] | 66 [54, 77] | 68 [57, 78] | 0.5 |
Age > 65 years | 256 (54.5) | 218 (53.4) | 38 (61.3) | 0.3 |
Male gender | 283 (60.2) | 245 (60.0) | 38 (61.3) | 0.9 |
SAPS II | 46.0 [32.0, 62.0] | 45 [32, 62] | 49 [37.3, 55.5] | 0.5 |
SOFA score | 7.0 [4.0, 9.0] | 6 [4, 9] | 7 [4.5, 8.5] | 0.6 |
Preexisting conditions | ||||
Heart failure | 65 (13.9) | 53 (13.0) | 12 (19.3) | 0.2 |
Peripheral arterial disease | 60 (12.8) | 45 (11.0) | 15 (24.2) | 0.007 |
Diabetes | 110 (23.5) | 91 (22.3) | 19 (36.8) | 0.2 |
Cirrhosis | 21 (4.5) | 18 (4.4) | 3 (4.8) | 0.8 |
Chronic obstructive pulmonary disease | 69 (14.7) | 59 (14.4) | 10 (16.1) | 0.9 |
Chronic kidney disease | 61 (13.0) | 52 (12.7) | 9 (14.5) | 0.8 |
Immunosuppression | 75 (16.0) | 62 (15.2) | 12 (19.3) | 0.5 |
Mechanical ventilation | 283 (60.2) | 248 (60.8) | 35 (56.5) | 0.6 |
Catecholamine use | 224 (47.8) | 190 (46.6) | 34 (54.8) | 0.3 |
Duration of mechanical ventilation (days) | 2.0 [0.0, 5.0] | 2.0 [0.0, 5.0] | 1.0 [0.0, 4.0] | 0.4 |
ICU length of stay (days) | 4.0 [2.0, 8.0] | 4 [2.0, 8.0] | 4.0 [3.0, 8.0] | 0.8 |
Transfer from another unit | 239 (50.9) | 206 (50.5) | 33 (53.2) | 0.8 |
Postoperative care | 109 (23.2) | 94 (23.0) | 14 (22.6) | 0.9 |
Hospitalization within the previous 3 months | 243 (51.7) | 204 (50) | 39 (62.9) | 0.08 |
Antibiotics within the previous 3 months | 81 (17.2) | 68 (16.7) | 13 (20.1) | 0.5 |
Antibiotics during ICU | 346 (73.6) | 303 (74.3) | 43 (69.3) | 0.5 |
Duration of antibiotic therapy | 3.0 [0.0, 6.0] | 3.0 [0.0, 6.0] | 3.0 [0.0, 7.0] | 0.8 |
Mortality | 62 (13.2) | 56 (13.7) | 6 (9.7) | 0.2 |
ESBL-imported carriage
Strain | Imported ESBL | Acquired ESBL | ||||||
---|---|---|---|---|---|---|---|---|
n
| CTXM 1 group | CTXM 9 group | Other group |
n
| CTXM 1 group | CTXM 9 group | Other group | |
E. coli
| 53 | 30 | 15 | 8 | 5 | 3 | 2 | 0 |
K. pneumoniae
| 10 | 8 | 0 | 2 | 1 | 1 | 0 | 0 |
E. cloacae
| 1 | 1 | 0 | 0 | 2 | 2 | 0 | 0 |
C. freundii
| 1 | 1 | 0 | 0 | 1 | 0 | 0 | 1 |
P. mirabilis
| 0 | 0 | 0 | 0 | 1 | 1 | 0 | 0 |
P. vulgaris
| 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 |
C. koseri
| 2 | 2 | 0 | 0 | 0 | 0 | 0 | 0 |
Total | 68 | 43 | 15 | 11 | 10 | 7 | 2 | 1 |
ESBL acquisition
Variable | All patients
n = 221 | No ESBL acquisition
n = 212 | ESBL acquisition
n = 9 |
p
|
---|---|---|---|---|
Age (years) | 67.0 [55.0, 77.0] | 66.5 [55.0, 76.0] | 82.0 [66.0, 82.0] | 0.07 |
Age > 65 years | 123 (55.6) | 116 (54.7) | 7 (78) | 0.3 |
Male gender | 144 (65.2) | 137 (64.6) | 7 (77.8) | 0.5 |
SAPS II | 49.0 [35.0, 66.0] | 48.0 [35.0, 65.0] | 72.0 [55.0, 77.0] | 0.007 |
SOFA score | 7.0 [4.0, 10.0] | 7.0 [4.0, 10.0] | 10.0 [9.0, 12.0] | 0.01 |
Preexisting condition | ||||
Heart failure | 32 (14.5) | 30 (14.1) | 2 (28.6) | 0.6 |
Peripheral arterial disease | 25 (11.3) | 22 (10.3) | 3 (33.3) | 0.07 |
Diabetes | 54 (24.4) | 51 (24) | 3 (33.3) | 0.5 |
Cirrhosis | 10 (4.5) | 9 (4.2) | 1 (11.1) | 0.4 |
Chronic obstructive pulmonary disease | 39 (17.6) | 37 (17.5) | 2 (22.2) | 0.7 |
Chronic kidney disease | 36 (16.3) | 32 (15.1) | 4 (44.4) | 0.04 |
Immunosuppression | 38 (17.2) | 36 (17.0) | 2 (22.2) | 0.7 |
Mechanical ventilation | 166 (75.1) | 157 (74.1) | 9 (100) | 0.1 |
Catecholamine use | 132 (59.7) | 123 (58.0) | 9 (100) | 0.01 |
Duration of mechanical ventilation (days) | 4.0 [1.0, 10.0] | 4.0 [0.0, 10.0] | 9.0 [7.0, 11.0] | 0.03 |
ICU length of stay (days) | 8.0 [5.0, 12.0] | 7.0 [5.0, 12.0] | 11.0 [9.0, 26.0] | 0.007 |
Transfer from another unit | 124 (56.1) | 117 (55.2) | 7 (77.8) | 0.3 |
Postoperative care | 58 (26.2) | 54 (25.5) | 4 (44.4) | 0.2 |
Hospitalization within the previous 3 months | 123 (55.7) | 117 (55.2) | 6 (66.7) | 0.7 |
Antibiotics within the previous 3 months | 40 (18.1) | 37 (17.5) | 3 (33.3) | 0.2 |
Antibiotics during ICU stay | 193 (87.3) | 184 (86.8) | 9 (100) | 0.6 |
Duration of antibiotic therapy | 5.0 [3.0, 8.0] | 5.0 [3.0, 8.0] | 8.0 [5.0, 13.5] | 0.1 |
Variable | Reference | Odds ratio | 95% Confidence interval |
---|---|---|---|
ICU length of stay (days) | |||
<4 | 3 | 0.92 | 0.82, 1.04 |
4–7 | 6 | 1.00 | 1.00, 1.00 |
7–10 | 9 | 1.08 | 0.96, 1.22 |
>10 | 15 | 1.28 | 0.89, 1.83 |
SAPS II | |||
<32 | 25 | 1.00 | 1.00, 1.00 |
33–45 | 40 | 1.89 | 1.11, 3.24 |
45–60 | 53 | 3.44 | 1.22, 9.68 |
>60 | 73 | 7.40 | 1.38, 39.59 |