Multidrug-resistant Organisms In Patients Research Articles

Infection with multi‑drug resistant organisms in patients with limb fractures: Analysis of risk factors and pathogens.

Infection with multi-drug resistant organisms (MDROs) has emerged as a global problem in medical institutions. Overuse of antibiotics is the main cause of drug resistance. Notably, the incidence of infection with MDROs increases in patients with limb fractures who have undergone invasive surgery. The present study aimed to analyze the risk factors for postoperative MDROs infection in a cohort of patients with limb fractures. A retrospective study was performed on the data of patients with fractures between January 2020 and August 2022. Postoperative surgical site infection occurred in 114 patients in total, of which 47 were infected with MDROs. Univariate logistic regression analysis and multivariate binary logistic regression were used to confirm the associations between independent risk factors and MDRO infection. A total of 155 bacteria were collected from patients with MDROs infection and patients with non-MDROs infection, of which 66.5% were gram-positive bacteria and 33.5% were gram-negative. Staphylococcus aureus accounted for 26.5% of the 155 pathogens. MDROs, such as methicillin-resistant S. aureus and extended-spectrum β-lactamases-positive gram-negative bacillus, were detected after antibiotic treatment. Univariate analysis indicated that the number of antibiotics administered, being bedridden, repeat infection, operative time and repeated operation were different in the two groups. In addition, univariate logistic analysis indicated that being bedridden (OR, 3.98; P=0.001), administration of >2 antibiotics (OR, 2.42; P=0.026), an operative time of >3 h (OR, 3.37; P=0.003), repeated infection (OR, 3.08; P=0.009) and repetition of procedures (OR, 2.25; P=0.039) were individual risk factors for MDRO infection. Multivariate analysis showed that being bedridden (OR, 2.66; P=0.037), repeated infection (OR, 4.00; P=0.005) and an operative time of >3 h (OR, 2.28; P=0.023) were risk factors of MDRO infection. In conclusion, constrained antibiotic use, shortened operative time and increased activity duration can effectively prevent surgical-site infection with MDROs in patients with fractures.

Microbiological profile of patients treated for postoperative peritonitis: temporal trends 1999–2019

BackgroundTemporal changes in the microbiological resistance profile have been reported in several life-threatening infections. However, no data have ever assessed this issue in postoperative peritonitis (POP). Our purpose was to assess the rate of multidrug-resistant organisms (MDROs) in POP over a two-decade period and to analyse their influence on the adequacy of empirical antibiotic therapy (EAT).MethodsThis retrospective monocentric analysis (1999–2019) addressed the changes over time in microbiologic data, including the emergence of MDROs and the adequacy of EAT for all intensive care unit adult patients treated for POP. The in vitro activities of 10 antibiotics were assessed to determine the most adequate EAT in the largest number of cases among 17 antibiotic regimens in patients with/without MDRO isolates. Our primary endpoint was to determine the frequency of MDRO and their temporal changes. Our second endpoint assessed the impact of MDROs on the adequacy of EAT per patient and their temporal changes based on susceptibility testing. In this analysis, the subgroup of patients with MDRO was compared with the subgroup of patients free of MDRO.ResultsA total of 1,318 microorganisms were cultured from 422 patients, including 188 (45%) patients harbouring MDROs. The growing proportions of MDR Enterobacterales were observed over time (p = 0.016), including ESBL-producing strains (p = 0.0013), mainly related to Klebsiella spp (p < 0.001). Adequacy of EAT was achieved in 305 (73%) patients. Decreased adequacy rates were observed when MDROs were cultured [p = 0.0001 vs. MDRO-free patients]. Over the study period, decreased adequacy rates were reported for patients receiving piperacillin/tazobactam in monotherapy or combined with vancomycin and imipenem/cilastatin combined with vancomycin (p < 0.01 in the three cases). In patients with MDROs, the combination of imipenem/cilastatin + vancomycin + amikacin or ciprofloxacin reached the highest adequacy rates (95% and 91%, respectively) and remained unchanged over time.ConclusionsWe observed high proportions of MDRO in patients treated for POP associated with increasing proportions of MDR Enterobacterales over time. High adequacy rates were only achieved in antibiotic combinations involving carbapenems and vancomycin, while piperacillin/tazobactam is no longer a drug of choice for EAT in POP in infections involving MDRO.Graphical

2693. Epidemiology of Infections with Multidrug-Resistant Organisms in Patients with Left Ventricular Assist Devices (LVADs)

Abstract Background Left ventricular assist devices (LVADs) constitute one of the limited options available to patients with refractory heart failure. Infection is the most common adverse event after LVAD placement, and difficult to eradicate when attributable to the LVAD itself. LVAD-attributable infections (LVADI) thus lead to significant antibiotic exposure and higher risk for antibiotic resistance. However, the epidemiology of multidrug-resistant organisms (MDROs) causing LVADI has not been described. Methods We conducted a retrospective cohort study of patients (pts) ≥18 years old with LVADs implanted from 2016 to 2022 at our institution. Infections were defined as LVADI if i) there was a positive culture from LVAD components, with or without concomitant blood cultures, or ii) there were positive blood cultures with radiologic evidence of LVADI. MDROs were defined according to the Centers for Disease Control (CDC) criteria. Primary outcome was mortality, and multivariate logistic models were built and adjusted for patient demographics and Charlson’s Comorbidity Index. Results A total of 252 pts were implanted with new LVADs, with 104 (41.2%) pts developing LVADI. Of the 52 episodes of bloodstream infection (BSI) in 41 pts, 36.5% were caused by MDRO, with Methicillin-Resistant Staphylococcus aureus (MRSA) and MDR Pseudomonas aeruginosa most frequent. There were an additional 64 pts with 99 infections with positive LVAD component cultures, with a total of 115 pathogens isolated. Of these, 20% were MDRO, with MRSA and MDR Enterobacterales most frequent. Multivariate logistic models showed that pts with LVADI did not have higher odds of mortality (OR =1.61; 95% CI [0.92 – 2.81]; p=0.1), however pts with MDRO LVADI had a greater than 3 times odds of mortality (OR = 3.34; 95%CI [1.68 – 6.64]; p&amp;lt; 0.001) compared to pts without MDRO LVADI. Conclusion Our review provides initial insight as to the burden of antibiotic resistance among bacteria causing LVADI. The frequency of LVADI in our cohort is higher than what has previously been reported, possibly due to higher vigilance. The MDROs MRSA, MDR Pseudomonas aeruginosa, and MDR Enterobacterales are prominent in this population. Further study is needed to elucidate the risk factors for acquiring MDRO LVADIs and contributing factors to mortality in LVAD pts. Disclosures All Authors: No reported disclosures

The Prevalence of Multidrug-Resistant Organisms in Patients with Surgical Site Infections in Riyadh, Saudi Arabia: A Cross-sectional Study at a Tertiary Care Hospital

Background: Multidrug-resistant (MDR) infections are a threat in patients undergoing surgery. This study was undertaken to determine the prevalence and possible predictors of MDR infections over a two-year period in patients with surgical site infection (SSI) at a tertiary care hospital in Riyadh, Saudi Arabia. Methods: We conducted a cross-sectional study from April 2016 to April 2018 by reviewing hospital records of patients with a diagnosis of SSI based on a physician report and laboratory findings. The isolation of MDR organisms (MDRO) from SSI was the primary outcome variable as well as other risk factors. Results: SSI was diagnosed in 55 out of 77 patients under study, with MDRO prevalence rate of 44%. Previous antibiotic use and hospitalization in the last 90 days were strongly associated with developing MDRO infection often due to ESBL producing Gram-negative bacterial pathogens. Superficial and deep incisional SSI were more frequent in patients compared to organ/space SSI. History of diabetes mellitus, duration of surgery and bacterial colonization at other body site also increased the likelihood of MDRO. Factors such as trauma, obesity, general anesthesia, and wound types were not found to increase the risk for MDRO. Conclusions: Our study identified recent antibiotic use and hospitalization as major risk factors for MDRO surgical site infections. Other predisposing factors include diabetes mellitus, duration of surgery and bacterial colonization. MDRO isolated include E. coli and Pseudomonas aeruginosa. Bacterial pathogens harboring multiple resistant mechanisms can complicate SSI adversely affecting clinical outcomes following routine surgical procedures.

The relationship between renal functions and multi-drug resistant organisms in patients with ventilator-associated pneumonia

Objective: Despite the increase in the frequency of multi-drug resistant organism (MDRO) colonisation and infection in dialysis&#x0D; patients, it is not well known whether the risk of multi-drug resistant (MDR) pneumonia increases in mild-to-severe chronic kidney&#x0D; disease patients not undergoing dialysis. Therefore, we aimed to evaluate the relationship between renal functions and the risk of MDR&#x0D; ventilator-associated pneumonia (VAP) and the specific microbial pattern.&#x0D; Patients and Methods: A total of 133 patients who developed VAP were divided according to their renal function into two groups, an&#x0D; estimated glomerular filtration rate of (eGFR) ≥ 60 mL/ min/1.73 m2 (high eGFR, n=65) and eGFR &lt; 60 mL/min/1.73 m2 (low eGFR,&#x0D; n=68).&#x0D; Results: The low eGFR group presented a significantly high MDRO ratio (p

Infection Characteristics and Drug Susceptibility of Multidrug-Resistant Bacteria in Patients with Diabetic Foot Ulcers.

We aimed to analyze the infection characteristics of multidrug-resistant organisms (MDROs) and their resistance to antibiotics in patients with diabetic foot and provide guidance for the use of antibiotics in clinical practice. The clinical data of 737 patients with diabetic foot who were hospitalized at our institution from February 2020 to January 2023 were retrospectively analyzed. Purulent secretions were collected from the patient's ulcers and bacterial culture, identification, and drug susceptibility tests were performed. The multidrug resistance (MDR) rate of different bacteria, composition ratio of MDROs, drug resistance characteristics of the main MDROs, distribution characteristics of multidrug-resistant gram-positive cocci and gram-negative bacilli in patients with different Wagner Grades, MDR in patients with different Wagner Grades, bacterial infection rate, and other indicators were analyzed. Pathogenic bacteria from wound secretions of 505 patients were cultured, and 509 pathogenic bacteria were obtained. Among the pathogenic bacteria, 225 strains were gram-positive cocci, of which 172 (76.44%) were MDROs, and 284 were gram-negative bacilli, of which 232 (81.69%) were MDROs. Among the 404 multidrug-resistant strains, gram-positive cocci and gram-negative bacilli accounted for 42.57% and 57.43%, respectively. The top five dominant MDROs were Staphylococcus aureus (18.56%), coagulase-negative Staphylococcus (10.89%), Escherichia coli (10.15%), Proteus mirabilis (8.17%), Proteus vulgaris (6.19%), and Pseudomonas aeruginosa (6.19%). Staphylococcus aureus and coagulase-negative Staphylococcus were more resistant to penicillin, oxacillin, erythromycin, azithromycin, and clarithromycin, with resistance rates of 50.0 - 95.0%. The resistance rates of E. coli to ampicillin, cefazolin, cefuroxime, ceftriaxone, and cefepime were > 75%. With an increase in Wagner Grade, the proportion of gram-negative bacilli among the pathogenic bacteria of MDROs increased significantly (p < 0.05), as did the infection rate of MDROs in patients with diabetic foot (χ2 = 14.045, p < 0.05). MDROs in patients with diabetic foot are mainly gram-negative bacilli, followed by gram-positive cocci. The drug resistance of various MDROs varies greatly. With the increase in Wagner Grade and MDR of diabetic foot patients, the infection rate of drug-resistant bacteria has increased significantly. Therefore, clinicians should use drugs rationally according to drug sensitivity results.

The pattern of antibiotic sensitivity of gram-negative MDR bacteria in patients admitted to the ICU

Due to the uncontrolled increase in the administration of antibiotics, the prevalence of multidrug-resistant organisms in patients admitted to intensive care units has also increased. Thus, this study aimed to investigate the pattern of sensitivity and compliance of treatment with the results of culture in gram-negative MDR bacteria in patients admitted to the intensive care unit of Shahid Sadoughi Hospital in Yazd. This cross-sectional study was performed over a period of one year on the results of culture of patients admitted to the intensive care unit of Shahid Sadoughi Hospital in Yazd (2020). The samples included blood, urine, wounds, bronchoalveolar lavage, shunt, and throat. All patient information and antibiotics prescribed were obtained using their records. Finally, the data was entered into SPSS (v. 26) and analyzed. In total, out of 298 patients for whom initial antibiotics were started experimentally, 226 cases had the culture results consistent with one of the antibiotics that were started initially. Among the antibiotics that were used more, clindamycin showed the least agreement with antibiotic sensitivity results. Among antibiotics, clindamycin had significantly the most compatibility in blood and urine and the least compatibility in wound. The present study showed a relatively good agreement in the initial experimental administration of antibiotics.

Multidrug-resistant organisms in patients from Ukraine in the Netherlands, March to August 2022.

Since March 2022, there has been an emergence of multidrug-resistant organisms (MDRO) in the Netherlands in patients originating from Ukraine (58 patients, 75 isolates). For about half of these patients, recent hospitalisation in Ukraine was reported. Genomic surveillance revealed that the majority of the MDRO represent globally spread epidemic lineages and that 60% contain New Delhi metallo-β-lactamase (NDM) genes. Professionals should be aware of an increase in such MDRO associated with migration and medical evacuation of people from Ukraine.

PD32-02 POPULATION BASED STUDY ON THE INCIDENCE AND RISKS OF MULTIDRUG-RESISTANT ORGANISMS IN PATIENTS WITH URETERIC STENTS

You have accessJournal of UrologyCME1 May 2022PD32-02 POPULATION BASED STUDY ON THE INCIDENCE AND RISKS OF MULTIDRUG-RESISTANT ORGANISMS IN PATIENTS WITH URETERIC STENTS Runhan Ren, Zoe Hsu, Erik Youngson, and Shubha De Runhan RenRunhan Ren More articles by this author , Zoe HsuZoe Hsu More articles by this author , Erik YoungsonErik Youngson More articles by this author , and Shubha DeShubha De More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002583.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteric stents can lead to irritative voiding symptoms which mimic UTIs. This population is thought to be at high risk of antibiotic over-exposure. Therefore, our objective was to assess local trends in antibiotic and multidrug-resistant organism (MDRO) patterns in patients with ureteric stents. METHODS: A population level retrospective cohort of patients undergoing ureteric stent insertion was created using provincially curated inpatient, ambulatory, and primary care data, through the Data Integration, Management and Reporting unit (DIMR) in Alberta (2013-18). Those with concurrent extirpative and reconstructive surgeries were excluded. Data 1 year pre- and post-stent insertion (SI) were collected, and descriptive analyses done on demographics, cultured organisms, prescriptions, and health care utilization. MDRO were defined as urine cultures (UC) with at least 3 resistances or known resistant species. Patients with post-SI MDRO were analyzed based on pre-SI urine culture results [no growth (NG), sensitive organisms (SO), and MDRO]. RESULTS: Over the study period, 13,820 SI were completed. 78% (n=10,786) had a single stent placement. 58% were placed for stones and 18% for hydronephrosis. 7,436 UC were completed post-SI, and 35.4% were positive. Organisms with any resistance increased from 16% of all cultures pre-SI to 23.6% post-SI, with E. coli being most common. Ciprofloxacin resistance for E. coli significantly increased from 35% to 50% (p<0.05) after SI. MDRO increased from 1.2% (n=164) to 5.9% (n=815) after SI. 42% of these stents were placed for hydronephrosis and 21% for stones. 40% of these patients underwent repeat SI in the following year. 217 patients with NG and 434 with SO developed MDRO post-SI, within 2.9 and 2.7 prescriptions respectively. Patients with pre-SI MDRO were more likely to receive antibiotic prescriptions in the following year (NG 5.5 vs SO 5.7 vs MDRO 7.0) and received Ciprofloxacin 24% of time. Unplanned emergency visits were similar post-SI for the three groups (4.0 vs 4.0 vs 4.7, p=0.23), but pre-SI MDRO had significantly more emergency visits in the year prior to SI (2.6 vs 3.1 vs 4.3, p<0.0001). CONCLUSIONS: An increase in MDRO was observed after SI which was associated with an increased number of antibiotic prescriptions and increasing ciprofloxacin resistance. Unplanned emergency visits were significantly higher in patients with pre-SI MDRO, but similar post-SI. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e547 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Runhan Ren More articles by this author Zoe Hsu More articles by this author Erik Youngson More articles by this author Shubha De More articles by this author Expand All Advertisement PDF DownloadLoading ...

Management of Multidrug-Resistant Infections in Cirrhosis.

The World Health Organization describes antimicrobial resistance as one of the biggest threats to global health, food security, and development with indiscriminate use of antimicrobials globally driving the emergence of multidrug-resistant bacteria, resistant to 60% of antimicrobials in some countries. Infections with multidrug-resistant organisms (MDROs) have increased in recent decades in patients with cirrhosis, who are frequently prescribed antibiotics, regularly undergo invasive procedures such as large volume paracentesis, and have recurrent hospitalizations, posing a particular risk in this already immunocompromised cohort of patients. In this review, we explore mechanisms underlying this vulnerability to MDRO infection; the effect of bacterial infections on disease course in cirrhosis; prevalence of MDROs in patients with cirrhosis; outcomes following MDRO infection; fungal infections; antibiotics and their efficacy; and management of MDRO infections in terms of detection, antimicrobial and nonantimicrobial treatments, prophylaxis, antibiotic stewardship, the gut microbiome, and technological interventions.

Colonization with Multidrug-resistant Organisms in Patients with Ventricular Assist Devices.

Infection is a leading cause of morbidity and mortality in patients with ventricular assist devices (VAD). The impact of colonization with multidrug-resistant organisms (MDRO) on outcomes in this cohort is unknown. Patients on VAD support from July 2008 to September 2018 at a single site were evaluated for MDRO colonization after implantation. MDROs included methicillin-resistant Staphylococcus aureus , vancomycin-resistant Enterococcus species, and extended-spectrum beta-lactamase producing gram-negative bacteria. 378 patients with 433 VADs were included. 42.6% (n = 161) of patients were colonized with an MDRO throughout the duration of VAD support. Eighty-two VAD infections occurred, 74.4% (n = 61) of whom were MDRO colonized before infection. MDRO colonization was associated with an increased risk of a subsequent VAD infection (hazard ratio 3.704, p < 0.001). MDRO colonization is common after VAD implantation and is associated with future VAD infections. Further study is needed to determine best management strategies for VAD recipients with MDRO colonization given this increased risk.

Limited Role for Antibiotics in COVID-19: Scarce Evidence of Bacterial Coinfection

Background: There is currently a paucity of data describing bacterial coinfections, related antibiotic prescribing patterns, and the potential role of antimicrobial stewardship in the care of patients infected with SARS-CoV-2. Methods: This prospective, observational study was conducted from March 10, 2020 to April 21, 2020 in admitted patients with confirmed COVID-19. Patients were included if ≥ 18 years old and admitted to the hospital for further treatment. Data was collected via chart review from the enterprise electronic health record database. Data collected include factors driving antibiotic choice, indication, and duration of therapy as well as microbiological data. Findings: Antibiotics were initiated on admission in 87/147 (59%) patients. Of these, 85/87 (98%) prescriptions were empiric. The most common indication for empiric antibiotics was concern for community-acquired pneumonia (76/85, 89%) with the most prescribed antibiotics being ceftriaxone and azithromycin. The median duration of antibiotic therapy was two days (interquartile range 1-5). No patients had a community-acquired bacterial respiratory coinfection, but 10/147 (7%) of patients were found to have concurrent bacterial infections from a non-respiratory source, and one patient was diagnosed with active pulmonary tuberculosis at the time of admission for COVID-19. Interpretation: Bacterial coinfection in patients with COVID-19 was infrequent. Antibiotics are likely unnecessary in patients with mild symptoms. There is little role for broad-spectrum antibiotics to empirically treat multidrug resistant organisms in patients with COVID-19, regardless of disease severity. Antimicrobial stewardship remains important in patients infected with SARS-CoV-2. Funding Statement: The authors received no funding for this work. Declaration of Interests: The authors report no relevant conflicts of interest. Ethics Approval Statement: The study was approved by the UTSW Medical Center institutional review board and informed consent was waived.

Prevalence of nosocomial infections by multidrug resistant organisms in patients admitted to the critical care area of the Regional cancer center, Gujarat, India

The Sri Lankan Journal of Infectious Diseases (SLJID) is an open access, peer-reviewed, biannual journal published by the Sri Lankan Society for Microbiology (SSM). The Journal considers articles from all professional disciplines involved in the field of infectious diseases. The Journal has been in publication since 2011, is included in the DOAJ since 2018 and is a member of COPE since 2021. The SLJID practices a double-blind peer review policy. From 2022, the SLJID publishes accepted manuscripts online immediately after copy-editing, enabling rapid dissemination of scientific knowledge. The published articles are subsequently compiled into two issues in April and October. The SLJID does not charge any article processing or publication fee.

2391. Increased Risk of Systemic Infections with Multidrug-Resistant Organisms in Patients with Severe Clostridioides difficile Infection

BackgroundThe gut microbiota is a defense mechanism against colonization of multidrug-resistant organisms (MDROs), including carbapenem-resistant Enterobacteriacae (CRE). Gut dysbiosis caused by broad-spectrum antibiotics favors MDRO colonization and increased susceptibility of intestinal infections, including C. difficile infection (CDI). Increased CDI severity may increase the risk of bacterial translocation due to damage to colonic epithelial layer. The aim of this study was to assess CDI disease severity and subsequent risk for MDRO systemic infection.MethodsThis was a prospective, observational study of adult hospitalized patients tested for CDI at a large, university-affiliated tertiary care hospital. Patients with a history of systemic MDRO infection in the past 90-days of stool testing were excluded. Patients were stratified by test positivity (CDI vs. antibiotic-associated diarrhea (AAD)), as well as, CDI disease severity and followed for 30-days for subsequent MDRO infections defined as presence of MDRO cultures from systemic, normally sterile sites (blood, urine, cerebrospinal fluid). Stool samples were collected and grown for MDRO colonization.ResultsA total of 335 CDI-positive and 135 antibiotic-associated diarrhea (AAD) hospitalized patients were included. No differences were found in rates of MDRO colonization by test positivity or disease severity (overall 68% VRE, 53% Candida spp., 30.4% MRSA, and 1.8% CRE). Significantly more patients with severe CDI had higher rates of developing systemic MDROs compared with mild-moderate CDI and AAD (23.2%, n = 112 vs. 8.1%, n = 223 P < 0.001; vs. 11.9%, p = 0.018). Severe CDI was found to be an independent risk factor for subsequent systemic MDRO infection via logistic regression.ConclusionSevere CDI disease is associated with an increased risk of systemic MDRO infections.Disclosures All authors: No reported disclosures.

Adverse clinical outcomes associated with multidrug-resistant organisms in patients with infected pancreatic necrosis

BackgroundMultidrug-resistant organisms (MDROs) is becoming a serious worldwide threat to public health. However, the impact of MDROs on the outcomes of the patients with infected pancreatic necrosis (IPN) remains unclear. This study aims to evaluate the roles of MDROs in IPN. MethodsA prospectively maintained database of 188 patients with IPN between January 2010 and May 2019 was analyzed. The microbiology profile of organisms isolated from wall-off necrosis (WON) was specifically investigated to correlate with the outcomes of the patients. ResultsOf the 188 patients with IPN, 108 patients (57.4%) had MDROs detected in aspirates from WON. Carbapenem-resistant Klebsiella pneumoniae (CRKP) accounted for 43.5% of the MDROs isolated (60/138), followed by Carbapenem-resistant Acinetobacter baumanii (CRAB) (34.8%, 48/138) and Escherichia coli producing an extended-spectrum beta-lactamase (ESBLp) (6.5%, 9/138). MDROs infection was associated with higher mortality (35.2% vs 11.3%, P < 0.001), higher rate of hemorrhage (36.1% vs 11.3%, P < 0.001), longer intensive care unit (ICU) stay (23 vs 12 days, P < 0.001), longer hospital stay (68 vs 51 days, P = 0.001) and more hospitalization expenses (45,190 ± 31,680 vs 26,965 ± 17,167 $, P < 0.001). Multivariate analysis of predictors of mortality indicated that MDROs infection (OR = 2.6; 95% confidence interval [CI], 1.0–6.5; P = 0.042), age ≥ 50 years (OR = 2.6; 95% CI, 1.2–5.8; P = 0.016), severe category (OR = 2.9; 95% CI, 1.1–8.0; P = 0.035), bloodstream infection (OR = 3.4; 95% CI, 1.5–7.6; P = 0.049), step-down surgical approach (OR = 2.7; 95% CI, 1.1–6.2; P = 0.023) were significant factors. ConclusionsMDROs infection was prevalent among patients with IPN and associated with adverse clinical outcomes and increased mortality.

Rate and impact of multidrug-resistant organisms in patients with aneurysmal subarachnoid hemorrhage.

Multidrug-resistant organisms (MDRO) are an increasing problem in critical care medicine. This study describes for the first time the rate and impact of MDRO in patients suffering from aneurysmal subarachnoid hemorrhage (SAH). Anonymized data of SAH patients admitted to our institution from November 2010 to August 2017 were retrospectively reviewed. Patients with microbiological tests positive for MDRO were identified. Screening of MDRO was in consensus with national recommendations. 449 SAH patients were reviewed with 18 patients (prevalence: four MDRO-positive patients per 100 SAH patients) having positive tests for MDRO during their hospital stay. The prevalence upon admission was 1.3 MDRO-positive patients per 100 patients. The acquisition rate was 1.1 MDRO-positive patients per 1000 hospital days. Patients positive for an MDRO had a significantly extended length of stay in intensive care (mean ± SD 26.7 ± 13.0 versus 18.4 ± 11.7days, p = 0.004) and in hospital (mean ± SD 33.9 ± 12.4 versus 24.4 ± 12.6days, p = 0.002). MDRO detection was associated with a significant prolonged duration of mechanical ventilation (median (IQR) 254.0 (14.9-632.8) versus 37.5 (3.3-277.0) hours, p = 0.02). There was no statistically significant effect on the Glasgow Outcome Scale (GOS) at discharge and at follow-up after 164.4 ± 113.0days. MDRO positivity is present in 4% of aneurysmal SAH patients. It seems to be associated with a prolonged length of stay and prolonged duration of mechanical ventilation. The importance of infection control standards in neurointensive care units is emphasized.

Prevalence of multidrug-resistant organisms in refugee patients, medical tourists and domestic patients admitted to a German university hospital

BackgroundPatients with contact to healthcare-system in high-prevalence countries (HPC) and refugee patients in hospital settings (REF) have previously been identified to be at risk of carrying multidrug-resistant organisms (MDRO). Comparative studies addressing the epidemiology of MDRO in patients transferred from hospitals abroad (ABROAD) and REF are lacking but are necessary to introduce refined infection control measures.MethodsFrom December 2015 to June 2016, 117 REF, 84 ABROAD and 495 patients admitted to intensive care unit, with no refugee history or pre-treatment abroad (ICU), at University Hospital Frankfurt, Germany (UHF) were screened for MDRO on day of admittance. Data within these groups were compared and set in an epidemiological context.Results52.1% (95% confidence interval = 42.7-61.5) of REF and 41.6% (31.0-52.9) of ABROAD, were positive for at least one MDRGN, respectively. In contrast, 7.9% (5.6-10.6) of ICU were positive for MDRGN. Thereof, 0.9% (0.0-4.7) of REF, 15.5% (8.5-25.0) of ABROAD and 0% (0.0-0.7) of ICU were positive for at least one MDRGN with carbapenem resistance (CR). In total, 19 MDRGN with CR were detected in ABROAD, with the most frequent species with CR being A. baumannii with 42.1% (20.3-66.5). Regarding MRSA, 10.3% (5.4-17.2) of REF, 5.9% (1.9-13.3) of ABROAD and a significantly lower proportion 1.4% (0.6-2.9) of ICU, respectively, were tested positive.ConclusionsBoth REF and ABROAD pose a relevant hospital hygiene risk. High prevalence of MDRGN with CR in ABROAD was observed. Concise screening and infection control guidelines are needed in patient cohorts with increased risk for MDRO carriage.

Risks for multidrug-resistant pathogens in the ICU.

The impact of multidrug-resistant organisms (MDROs) is rising and often underestimated. The epidemiology of MDROs is extremely complex and multifactorial. There is increasing antibiotic resistance, mainly related to antibiotic pressure and patients' characteristics. Emphasis on MDRO epidemiology is needed to better understand current strategies of prevention and management. Among them, antibiotic stewardship has been one of the most successful strategies. It is important to note that there is a controversial issue when considering community and healthcare-related infections. In addition, different strategies have been determined to find the impact and optimal use of recently launched antibiotics for MDRO treatment. Infections with MDROs can prolong hospital stay, promote antibiotic use and prolong duration of mechanical ventilation. Some points should be further explored in clinical research such as the heterogeneity of healthcare-associated pneumonia and the need of new drug development. Resistance to non fermentative Gram-negative bacilli, rising minimum inhibitory concentration in methicillin-resistant Staphylococcus aureus and spread of MDROs in patients without known risk factors suggest a review of guideline validation, taking into account ecology and severity of patient illness to provide timely and appropriate empiric therapy.

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Introduction: Based upon ATS/IDSA guideline recommendations for the management of adults with healthcare-associated pneumonia, patients with early-onset infection (within 4 days of admission) without risk factors for multidrug-resistant (MDR) pathogens should receive empiric monotherapy. However, more recent data suggests that this early- and late-onset classification should be abandoned as similar pathogens and mortality have been identified in the two subgroups of patients. Hypothesis: We hypothesize that there is no difference in the incidence of MDR pathogens between episodes of early-onset and late-onset pneumonia within our institution. Methods: We conducted a retrospective chart review of respiratory cultures (endotracheal aspirates and bronchoalveolar lavages) obtained at our institution between June 2008 and December 2011. Results: Five hundred eighty four cultures were reviewed to include 150 patients. Thirty-nine of 65 (60%) patients with early-onset pneumonia had infection with MDR organisms versus 63 of 85 (74%) patients with late-onset pneumonia (p=0.07). In patients with early-onset pneumonia with and without risk factors, MDR organisms accounted for 24 of 33 (73%) and 15 of 32 (47%) infections, respectively (p=0.04). Compared to the 47% incidence of MDR pathogens in patients without risk factors, MDR organisms were identified in 74% (87 of 118) of all patients with expected risk of MDR pathogens (late onset/other risk factors) (p=0.005). No difference was observed in mechanical ventilator-free days, intensive care unit length of stay, or mortality between the latter two groups described. Conclusions: We observed a similar incidence of infection with MDR pathogens in patients with early- and late-onset pneumonia; however, more MDR pathogens were observed in patients with risk factors for MDR pathogens regardless of timing of onset. While this study confirms the high incidence of pneumonia associated with MDR organisms in patients with risk factors, half of patients with early-onset pneumonia without identified risk factors experienced infection with MDR organisms. Consideration should be given to broad-spectrum empiric antibiotic regimens in patients with early-onset pneumonia in our hospital.

Low incidence of multidrug-resistant organisms in patients with healthcare-associated pneumonia requiring hospitalization

Healthcare-associated pneumonia (HCAP) includes a broad spectrum of patients who acquire pneumonia through outpatient contact with the health system. Although limited prospective data exist, it has been suggested that all patients with HCAP should receive empirical therapy with a multidrug regimen directed against drug-resistant organisms. We aimed to determine the differences in aetiology and outcomes between HCAP groups and a community-acquired pneumonia (CAP) group, and to assess the presence of antibiotic-resistant bacteria. All consecutive non-immunocompromised adults hospitalized with pneumonia were prospectively included from 2001 to 2009. Patients who had had recent contact with the health system through nursing homes, home healthcare programmes, haemodialysis clinics or prior hospitalization were considered to have HCAP. A total of 2245 patients with pneumonia were hospitalized through the emergency room, of whom 577 (25.7%) had HCAP. Significant differences in causative pathogens were found between groups. Antibiotic-resistant organisms, including methicillin-resistant Staphylococcus aureus, resistant strains of Pseudomonas aeruginosa, and extendedspectrum β-lactamase-producing Enterobacteriaceae, were scarce in all groups. In contrast, aspiration pneumonia was particularly frequent. No differences were found regarding inappropriate initial empirical antibiotic therapy between groups. Overall mortality was higher in patients who attended a hospital or haemodialysis clinic or received intravenous chemotherapy in the 30 days before pneumonia, and among patients who resided in a nursing home or long-term-care facility. In conclusion, most HCAP patients could be treated in the same way as patients with CAP, after carefully ruling out the presence of aspiration pneumonia.