Abstract
ObjectiveRectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) probably precedes infection. We aimed to assess the association between rectal HR-GNR colonization and subsequent HR-GNR infection in clinical patients during a follow-up period of one year in a historical cohort study design.MethodsRectal HR-GNR colonization was assessed by culturing. Subsequent development of infection was determined by assessing all clinical microbiological culture results extracted from the laboratory information system including clinical data regarding HR-GNR infections. A multivariable logistic regression model was constructed with HR-GNR rectal colonization as independent variable and HR-GNR infection as dependent variable. Gender, age, antibiotic use, historic clinical admission and previous (HR-GNR) infections were included as possible confounders.Results1133 patients were included of whom 68 patients (6.1%) were colonized with a HR-GNR. In total 22 patients with HR-GNR infections were detected. Urinary tract infections were most common (n = 14, 63.6%), followed by bloodstream infections (n = 5, 22.7%) and other infections (n = 8, 36.4%). Eight out of 68 HR-GNR colonized patients (11.8%) developed a subsequent HR-GNR infection compared to 14 out of 1065 HR-GNR negative patients (1.3%), resulting in an odds ratio (95% CI) of 7.1 (2.8–18.1) in the multivariable logistic regression analyses.ConclusionsRectal colonization with a HR-GNR was a significant risk factor for a subsequent HR-GNR infection.This implies that historical colonization culture results should be considered in the choice of empirical antibiotic therapy to include coverage of the cultured HR-GNR, at least in critically ill patients.
Highlights
Infections are frequently seen by general practitioners (GPs) and medical specialists in the Netherlands [1]
Subsequent development of infection was determined by assessing all clinical microbiological culture results extracted from the laboratory information system including clinical data regarding Highly Resistant Gram-negative Rods (HR-GNRs) infections
1133 patients were included of whom 68 patients (6.1%) were colonized with a HR-GNR
Summary
Infections are frequently seen by general practitioners (GPs) and medical specialists in the Netherlands [1]. A rapid diagnosis and effective empirical antibiotic therapy are important to prevent complications. Rising resistance rates hamper effective antibiotic treatment increasing the risk of treatment failure and complications [3]. We wanted to determine if rectally HR-GNR colonized patients are at increased risk of developing a HR-GNR infection. These insights could be helpful in timely application of the most appropriate antibiotic treatment. When rectal HR-GNR colonisation is associated with an increased risk of a subsequent HR-GNR infection, identification of colonized patients and prevention of colonization becomes more important, because of the implications that it will have for patients. In order to study this association the present study was designed
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
