Background
Methods
Ethics statement
Setting
Patient inclusion and microbiological analysis
Network analysis
Definite1 | Probable | Possible-I | Possible-II | Impossible | |
---|---|---|---|---|---|
Same patient room | 1 | 1 | 0 | 0 | 0 |
Same department | 1 | 1 | 1 | 1 | 0 |
Same period | 1 | 0a | 1 | 0a | 0a/0/1 |
Case-control studies
Control groups
Statistical analyses
Results
Included patients
Network analysis
Case-control studies
Matching
Risk factors for acquisition
Variables | Cases (n = 144) | Controls 1&2 (n = 288) | Crude OR (95% CI) | P-value | Controls 3&4 (n = 288) | Crude OR (95% CI) | P-value |
---|---|---|---|---|---|---|---|
Basic characteristics | |||||||
Age, years, median (range) | 58.3 (17–82) | 60.3 (17–92) | 0.998 (0.986–0.1010) | 0.723 | 61.1 (17–91) | 0.995 (0.982–1.007) | 0.407 |
Male gender (%) | 83 (57.6) | 174 (60.4) | 0.886 (0.584–1.345) | 0.570 | 167 (58.0) | 0.985 (0.650–1.493) | 0.944 |
28-day mortality (%) | 41 (28.5) | 69 (24.0) | 1.283 (0.804–2.048) | 0.296 | 40 (13.9) |
2.677 (1.577–4.544)
|
< 0.001
|
1-year mortality (%) | 82 (56.9) | 95 (33.0) |
2.680 (1.754–4.094)
|
< 0.001
| 63 (21.9) |
4.950 (3.072–7.976)
|
< 0.001
|
Transferred from another hospital (%) | 50 (34.7) | 60 (20.8) |
2.000 (1.279–3.128)
|
0.002
| 50 (17.4) |
2.405 (1.530–3.782)
|
< 0.001
|
Median length of admission (range) | 55 (3–338) | 25 (1–258) |
1.021 (1.014–1.028)
|
< 0.001
| 12 (1–1102) |
1.021 (1.014–1.027)
|
< 0.001
|
Erasmus MC 1y before VIM-PA (%) | 64 (44.4) | 111 (38.5) | 1.278 (0.851–1.920) | 0.237 | 109 (37.8) | 1.348 (0.881–2.064) | 0.169 |
Erasmus MC ICU 1y before VIM-PA (%) | 14 (9.7) | 15 (5.2) | 1.867 (0.901–3.867) | 0.093 | 14 (4.9) | 2.131 (0.976–4.652) | 0.058 |
Surgery (%) | 87 (60.4) | 119 (41.3) |
2.165 (1.432–3.275)
|
< 0.001
| 121 (42.0) |
2.119 (1.399–3.209)
|
< 0.001
|
Underlying diseases | |||||||
Cystic fibrosis (%) | 2a (1.4) | 3 (1.0) | NA | NA | 2 (0.7) | NA | NA |
Chronic respiratory illness (%) | 29 (20.1) | 43 (14.9) | 1.488 (0.861–2.571) | 0.155 | 43 (14.9) | 1.518 (0.868–2.655) | 0.144 |
Chronic kidney failure (%) | 5 (3.5) | 3 (1.0) | 3.33 (0.797–13.948) | 0.099 | 11 (3.8) | 0.903 (0.304–2.689) | 0.855 |
Acute kidney failure; use of CVVH (%) | 28 (19.4) | 18 (6.3) |
3.471 (1.844–6.533)
|
< 0.001
| 10 (3.5) |
6.651 (3.022–14.638)
|
< 0.001
|
Chronic liver failure (%) | 5 (3.5) | 7 (2.4) | 1.480 (0.442–4.952) | 0.525 | 17 (5.9) | 0.588 (0.217–1.594) | 0.297 |
Acute liver failure (%) | 0 (0) | 6 (2.1) | NA | NA | 3 (1.0) | NA | NA |
Chronic problems of the gastrointestinal tract (%) | 19 (13.2) | 28 (9.7) | 1.377 (0.758–2.502) | 0.294 | 26 (9.0) | 1.603 (0.822–3.126) | 0.166 |
Acute problems of the gastrointestinal tract (%) | 28 (19.4) | 39 (13.5) | 1.493 (0.894–2.494) | 0.126 | 54 (18.8) | 1.047 (0.627–1.750) | 0.861 |
Auto-immune disease (%) | 7 (4.9) | 18 (6.3) | 0.762 (0.308–1.886) | 0.556 | 26 (9.0) | 0.520 (0.221–1.223) | 0.134 |
Human immunodeficiency virus (%) | 0 (0) | 2 (0.7) | NA | NA | 4 (1.4) | NA | NA |
Diabetes (%) | 24 (16.7) | 37 (12.8) | 1.353 (0.776–2.360) | 0.287 | 48 (16.7) | 1.000 (0.579–1.726) | 1.000 |
Solid organ transplant recipient (%) | 20a (14.0) | 20 (6.9) |
2.257 (1.139–4.473)
|
0.020
| 30 (10.4) | 1.463 (0.784–2.729) | 0.232 |
Stem cell/bone marrow transplant recipient (%) | 7a (4.9) | 6 (2.1) | 3.562 (0.875–14.493) | 0.076 | 1 (0.3) | NA | NA |
Use of immunosuppressive agents (%) | 55 (38.2) | 71 (24.7) |
1.920 (1.236–2.985)
|
0.004
| 55 (19.1) |
2.493 (1.602–3.879)
|
< 0.001
|
Malignancies (%) | 32 (22.2) | 76 (26.4) | 0.777 (0.472–1.280) | 0.322 | 92 (31.9) |
0.570 (0.347–0.936)
|
0.026
|
Neutropenia, < 500 cells/μL (%) | 3b (2.7) | 4b (2.1) | 0.883 (0.159–4.889)b | 0.886 | 7b (2.4) | 0.667 (0.164–2.713)b | 0.571 |
Endoscopies | |||||||
Colonoscopy (%) | 7 (4.9) | 10 (3.5) | 1.400 (0.533–3.678) | 0.495 | 12 (4.2) | 1.202 (0.432–3.345) | 0.724 |
Sigmoidoscopy (%) | 7 (4.9) | 5 (1.7) | 2.800 (0.889–8.822) | 0.079 | 8 (2.8) | 1.750 (0.635–4.826) | 0.280 |
Endoscopic ultrasound (%) | 7 (4.9) | 26 (9.0) | 0.490 (0.202–1.189) | 0.115 | 19 (6.6) | 0.684 (0.260–1.802) | 0.443 |
Gastroscopy (%) | 75 (52.1) | 50 (17.4) |
6.609 (3.803–11.485)
|
< 0.001
| 59 (20.5) |
4.529 (2.79–7.335)
|
< 0.001
|
ERCP (%) | 17 (11.8) | 15 (5.2) |
2.520 (1.190–5.336)
|
0.016
| 10 (3.5) |
3.917 (1.678–9.143)
|
0.002
|
Bronchoscopy (%) | 41 (28.5) | 34 (11.8) |
3.159 (1.841–5.422)
|
< 0.001
| 33 (11.5) |
3.030 (1.800–5.103)
|
< 0.001
|
Transoesophageal Echocardiography (TEE) (%) | 12 (8.3) | 13 (4.5) | 1.846 (0.842–4.046) | 0.126 | 13 (4.5) | 1.901 (0.849–4.257) | 0.118 |
Medical devices | |||||||
Mechanical ventilation (%) | 129 (89.6) | 210 (72.9) |
4.921 (2.284–10.600)
|
< 0.001
| 185 (64.2) |
8.211 (3.857–17.481)
|
< 0.001
|
Tracheostomy (%) | 29 (20.1) | 38 (13.2) |
1.801 (1.011–3.211)
|
0.046
| 9 (3.1) |
7.883 (3.443–18.045)
|
< 0.001
|
Extracorporeal membrane oxygenation (%) | 2 (1.4) | 0 (0) | NA | NA | 0 (0) | NA | NA |
Central venous catheter (%) | 103 (71.5) | 124 (43.1) |
4.121 (2.477–6.854)
|
< 0.001
| 77 (26.7) |
9.040 (5.101–16.023)
|
< 0.001
|
Variablesc | Cases (n = 138a) | Controls 1&2 (n = 288) | Crude OR (95% CI) | P-value | Controls 3&4 (n = 288) | Crude OR (95% CI) | P-value |
---|---|---|---|---|---|---|---|
Antifungals (%) | 82 (59.4) | 79 (28.0)b |
4.863 (2.886–8.194)
|
< 0.001
| 50 (17.7)b |
5.890 (3.647–9.512)
|
< 0.001
|
Antivirals (%) | 16 (11.6) | 19 (6.7)b | 1.913 (0.899–4.071) | 0.092 | 17 (6.0)b |
2.053 (1.011–4.169)
|
0.047
|
Aminoglycosides (%) | 51 (37.0) | 53 (18.8) |
2.988 (1.769–5.046)
|
< 0.001
| 24 (8.5) |
6.832 (3.692–12.643)
|
< 0.001
|
Amoxicillin/clavulanic acid (%) | 39 (29.1) | 48 (17.0)b |
2.014 (1.196–3.394)
|
0.009
| 40 (14.2)b |
2.388 (1.428–3.992)
|
0.001
|
Carbapenems (%) | 58 (42.0) | 58 (20.7) |
3.124 (1.898–5.142)
|
< 0.001
| 26 (9.2) |
6.762 (3.810–12.000)
|
< 0.001
|
Cephalosporins (%) | 104 (77.6) | 131 (46.5) |
3.942 (2.383–6.520)
|
< 0.001
| 107 (37.9) |
6.407 (3.692–11-121)
|
< 0.001
|
Colistin (%) | 17 (12.7) | 20 (7.1)b | 1.896 (0.926–3.880) | 0.080 | 12 (4.3)b |
4.282 (1.756–10.437)
|
0.001
|
Macrolides (%) | 60 (44.8) | 64 (22.7) |
2.702 (1.696–4.304)
|
< 0.001
| 27 (9.6) |
6.881 (3.885–12.190)
|
< 0.001
|
Metronidazole (%) | 48 (35.8) | 48 (17.0) |
2.445 (1.534–3.898)
|
< 0.001
| 32 (11.3)b |
4.689 (2.630–8.360)
|
< 0.001
|
Nitrofurantoin (%) | 17 (12.7) | 12 (4.3)b |
3.486 (1.543–7.878)
|
0.003
| 24 (8.5) | 1.527 (0.767–3.039) | 0.228 |
Penicillin (%) | 29 (21.6) | 49 (17.4) | 1.226 (0.739–2.032) | 0.431 | 31 (11.0) |
2.100 (1.199–3.678)
|
0.009
|
Piperacillin/tazobactam (%) | 49 (36.6) | 50 (17.7)b |
2.774 (1.666–4.621)
|
< 0.001
| 32 (11.3)b |
4.572 (2.604–8.025)
|
< 0.001
|
Quinolones (%) | 94 (70.1) | 88 (31.2) |
6.087 (3.553–10.429)
|
< 0.001
| 53 (18.8) |
9.193 (5.284–15.996)
|
< 0.001
|
Trimethoprim/sulfamethoxazole (%) | 32 (23.9) | 23 (8.2)b |
3.606 (1.930–6.740)
|
< 0.001
| 19 (6.7)b |
3.834 (2.098–7.007)
|
< 0.001
|
Vancomycin (%) | 74 (55.2) | 51 (18.1) |
6.355 (3.652–11.057)
|
< 0.001
| 27 (9.6) |
9.847 (5.437–17.836)
|
< 0.001
|
Other antibiotics (%) | 32 (23.9) | 28 (9.9)b |
3.074 (1.680–5.627)
|
< 0.001
| 30 (10.6)b |
2.684 (1.512–4.763)
|
0.001
|
Selective digestive tract decontamination (%) | 92 (68.7) | 109 (38.7) |
4.583 (2.641–7.952)
|
< 0.001
| 59 (20.9) |
10.864 (5.748–20.536)
|
< 0.001
|