First multicenter study on multidrug resistant bacteria carriage in Chinese ICUs

BMC Infectious Diseases

Research Article

Qian Xu¹  Shumei Sun²  Xiaojun Ma³  Liuyi Li⁴  Yinghong Wu⁵  Jérôme Robert⁶  Vincent Jarlier⁶  Yuxing Ni⁷  Anhua Wu⁸  Bijie Hu⁹ 

[1] China-Japan Friendship Hospital, Beijing, China;Nanfang Hospital, Southern Medical University, Guandong, China;Peking Union Medical College Hospital, Beijing, China;Peking University First Hospital, Beijing, China;Peking University People’s Hospital, Beijing, China;Pitié-Salpêtrière University Hospital, Assistance Publique des Hôpitaux de Paris (APHP), Paris, France;Sorbonne Universités, UPMC Univ Paris 06, CR7, INSERM U1135, Centre d’Immunologie et des Maladies Infectieuses, CIMI, Team E13 (Bacteriology), F-75013, Paris, France;Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China;Xiangya Hospital, Central South University, Changsha, China;Zhongshan Hospital Fudan University, Shanghai, China;

关键词: Intensive Care Unit;    Intensive Care Unit Admission;    Attack Rate;    Intensive Care Unit Discharge;    Antibiotic Exposure;   

DOI  :  10.1186/s12879-015-1105-7

 received in 2015-03-17, accepted in 2015-08-12,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundThe importance of multidrug-resistant organisms (MDRO) in Chinese hospitals is not clearly delineated. Thus we sought to assess the prevalence of MDRO in Chinese intensive care units (ICUs).MethodsProspective study of inpatients admitted consecutively to eight ICUs in four Chinese cities in 2009–10. Admission and weekly screenings were performed by using selective media for methicillin resistant Staphylococcus aureus, extended-spectrum beta-lactamase-producing Enterobacteriaceae, Acinetobacter and Pseudomonas aeruginosa. For the two latters, resistance to ceftazidime defined MDRO. Backward logistic regression models were designed to assess factors independently associated with MDRO carriage on admission and MDRO acquisition within ICUs.Results686 patients were included, and the MDRO prevalence rate on admission was 30.5 % (32.7 % for ESBL-positive Enterobacteriaceae, 3.2 % for MRSA). Antibiotic treatment prior to ICU admission was independently associated with carriage on admission (OR: 1.4) in multivariate analysis. A total of 104 patients acquired ≥1 MDRO in ICU (overall attack rate: 23.7 %; 14.9 % for ESBL-positive Enterobacteriaceae, and 5.1 % for MRSA). The MDRO attack rate increased from 13.2 % in the first week to 82.1 % for ICU stay > 3 weeks. Duration of antibiotic exposure (OR: 1.16; 1.1–1.2) and prior antibiotic treatment before ICU (OR: 2.1; 1.1–3.3) were associated with MDRO acquisition in multivariate analysis. The MDRO prevalence rate on ICU discharge was 51.2 % and the global prevalence density rate 71 per 1000 hospital-days.ConclusionMore than one out of two patients was MDRO carrier on ICU discharge in Chinese hospitals. This is the result of the combination of a high MDRO prevalence rate on ICU admission and a high MDRO acquisition rate within ICU.

【 授权许可】

CC BY   
© MA et al. 2015