Bloodstream Infections Caused by Carbapenem-Resistant Pathogens in Intensive Care Units: Risk Factors Analysis and Proposal of a Prognostic Score
Considering the growing prevalence of carbapenem-resistant Gram-negative bacteria (CR-GNB) bloodstream infection (BSI) in intensive care units (ICUs), the identification of specific risk factors and the development of a predictive model allowing for the early identification of patients at risk for C...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-06-01
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| Series: | Pathogens |
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| Online Access: | https://www.mdpi.com/2076-0817/11/7/718 |
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| author | Giorgia Montrucchio Andrea Costamagna Tommaso Pierani Alessandra Petitti Gabriele Sales Emanuele Pivetta Silvia Corcione Antonio Curtoni Rossana Cavallo Francesco Giuseppe De Rosa Luca Brazzi |
| author_facet | Giorgia Montrucchio Andrea Costamagna Tommaso Pierani Alessandra Petitti Gabriele Sales Emanuele Pivetta Silvia Corcione Antonio Curtoni Rossana Cavallo Francesco Giuseppe De Rosa Luca Brazzi |
| author_sort | Giorgia Montrucchio |
| collection | DOAJ |
| description | Considering the growing prevalence of carbapenem-resistant Gram-negative bacteria (CR-GNB) bloodstream infection (BSI) in intensive care units (ICUs), the identification of specific risk factors and the development of a predictive model allowing for the early identification of patients at risk for CR-<i>Klebsiella pneumoniae</i>, <i>Acinetobacter baumannii</i> or <i>Pseudomonas aeruginosa</i> are essential. In this retrospective case–control study including all consecutive patients showing an episode of BSI in the ICUs of a university hospital in Italy in the period January–December 2016, patients with blood culture positive for CR-GNB pathogens and for any other bacteria were compared. A total of 106 patients and 158 episodes of BSI were identified. CR-GNBs induced BSI in 49 patients (46%) and 58 episodes (37%). Prognosis score and disease severity at admission, parenteral nutrition, cardiovascular surgery prior to admission to ICU, the presence of sepsis and septic shock, ventilation-associated pneumonia and colonization of the urinary or intestinal tract were statistically significant in the univariate analysis. The duration of ventilation and mortality at 28 days were significantly higher among CR-GNB cases. The prognostic model based on age, presence of sepsis, previous cardiovascular surgery, SAPS II, rectal colonization and invasive respiratory infection from the same pathogen showed a C-index of 89.6%. The identified risk factors are in line with the international literature. The proposal prognostic model seems easy to use and shows excellent performance but requires further studies to be validated. |
| first_indexed | 2024-03-09T10:13:58Z |
| format | Article |
| id | doaj.art-ebd0de5c908b4392a7e5c38274e02e71 |
| institution | Directory Open Access Journal |
| issn | 2076-0817 |
| language | English |
| last_indexed | 2024-03-09T10:13:58Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pathogens |
| spelling | doaj.art-ebd0de5c908b4392a7e5c38274e02e712023-12-01T22:32:25ZengMDPI AGPathogens2076-08172022-06-0111771810.3390/pathogens11070718Bloodstream Infections Caused by Carbapenem-Resistant Pathogens in Intensive Care Units: Risk Factors Analysis and Proposal of a Prognostic ScoreGiorgia Montrucchio0Andrea Costamagna1Tommaso Pierani2Alessandra Petitti3Gabriele Sales4Emanuele Pivetta5Silvia Corcione6Antonio Curtoni7Rossana Cavallo8Francesco Giuseppe De Rosa9Luca Brazzi10Department of Surgical Sciences, University of Turin, 10126 Turin, ItalyDepartment of Surgical Sciences, University of Turin, 10126 Turin, ItalyDepartment of Surgical Sciences, University of Turin, 10126 Turin, ItalyDepartment of Surgical Sciences, University of Turin, 10126 Turin, ItalyDepartment of Surgical Sciences, University of Turin, 10126 Turin, ItalyDepartment of General and Specialized Medicine, Division of Emergency Medicine and High Dependency Unit, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, ItalyDepartment of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, ItalyMicrobiology and Virology Unit, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, ItalyMicrobiology and Virology Unit, Città Della Salute e Della Scienza di Torino University Hospital, 10126 Turin, ItalyDepartment of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, ItalyDepartment of Surgical Sciences, University of Turin, 10126 Turin, ItalyConsidering the growing prevalence of carbapenem-resistant Gram-negative bacteria (CR-GNB) bloodstream infection (BSI) in intensive care units (ICUs), the identification of specific risk factors and the development of a predictive model allowing for the early identification of patients at risk for CR-<i>Klebsiella pneumoniae</i>, <i>Acinetobacter baumannii</i> or <i>Pseudomonas aeruginosa</i> are essential. In this retrospective case–control study including all consecutive patients showing an episode of BSI in the ICUs of a university hospital in Italy in the period January–December 2016, patients with blood culture positive for CR-GNB pathogens and for any other bacteria were compared. A total of 106 patients and 158 episodes of BSI were identified. CR-GNBs induced BSI in 49 patients (46%) and 58 episodes (37%). Prognosis score and disease severity at admission, parenteral nutrition, cardiovascular surgery prior to admission to ICU, the presence of sepsis and septic shock, ventilation-associated pneumonia and colonization of the urinary or intestinal tract were statistically significant in the univariate analysis. The duration of ventilation and mortality at 28 days were significantly higher among CR-GNB cases. The prognostic model based on age, presence of sepsis, previous cardiovascular surgery, SAPS II, rectal colonization and invasive respiratory infection from the same pathogen showed a C-index of 89.6%. The identified risk factors are in line with the international literature. The proposal prognostic model seems easy to use and shows excellent performance but requires further studies to be validated.https://www.mdpi.com/2076-0817/11/7/718carbapenemmultidrug resistanceantimicrobial resistanceGram-negative bacteriabloodstream infectionsepsis |
| spellingShingle | Giorgia Montrucchio Andrea Costamagna Tommaso Pierani Alessandra Petitti Gabriele Sales Emanuele Pivetta Silvia Corcione Antonio Curtoni Rossana Cavallo Francesco Giuseppe De Rosa Luca Brazzi Bloodstream Infections Caused by Carbapenem-Resistant Pathogens in Intensive Care Units: Risk Factors Analysis and Proposal of a Prognostic Score Pathogens carbapenem multidrug resistance antimicrobial resistance Gram-negative bacteria bloodstream infection sepsis |
| title | Bloodstream Infections Caused by Carbapenem-Resistant Pathogens in Intensive Care Units: Risk Factors Analysis and Proposal of a Prognostic Score |
| title_full | Bloodstream Infections Caused by Carbapenem-Resistant Pathogens in Intensive Care Units: Risk Factors Analysis and Proposal of a Prognostic Score |
| title_fullStr | Bloodstream Infections Caused by Carbapenem-Resistant Pathogens in Intensive Care Units: Risk Factors Analysis and Proposal of a Prognostic Score |
| title_full_unstemmed | Bloodstream Infections Caused by Carbapenem-Resistant Pathogens in Intensive Care Units: Risk Factors Analysis and Proposal of a Prognostic Score |
| title_short | Bloodstream Infections Caused by Carbapenem-Resistant Pathogens in Intensive Care Units: Risk Factors Analysis and Proposal of a Prognostic Score |
| title_sort | bloodstream infections caused by carbapenem resistant pathogens in intensive care units risk factors analysis and proposal of a prognostic score |
| topic | carbapenem multidrug resistance antimicrobial resistance Gram-negative bacteria bloodstream infection sepsis |
| url | https://www.mdpi.com/2076-0817/11/7/718 |
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