Extensively drug-resistant and multidrug-resistant gram-negative pathogens in the neurocritical intensive care unit
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ORIGINAL ARTICLE - INFECTION
Extensively drug-resistant and multidrug-resistant gram-negative pathogens in the neurocritical intensive care unit Marina Munari 1 & Francesca Franzoi 1 & Massimo Sergi 1 & Alessandro De Cassai 1 & Federico Geraldini 1 & Marzia Grandis 1 & Massimiliano Caravello 1 & Annalisa Boscolo 1 & Paolo Navalesi 1,2 Received: 24 August 2020 / Accepted: 5 October 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background Abrupt increase of multidrug-resistant, extensively drug-resistant, and pandrug-resistant bacteria may complicate the course, management, and costs of neurocritical patients and is associated with high morbidity and mortality rates. No data exists regarding risk factors for colonization by gram-negative pathogens in neurocritical patients. The aim of the study was to identify risk factors associated with colonization by multidrug-resistant, extensively drug-resistant, and pandrug-resistant gramnegative bacteria in neurocritical patients. Methods We conducted a retrospective cohort study in a neurointensive care unit over a period of 3 years. We included adult neurocritical patients admitted for more than 48 h. We analyzed several factors including both anamnestic factors and admission diagnosis. Results Four hundred twenty neurocritical patients were retrospectively enrolled. Seventy-three patients developed colonization by multidrug-resistant and 53 by extensively drug-resistant gram negative pathogens. Logistic regression identified intensive care unit length of stay (LOS) as the strongest predictor for both multidrug-resistant (AUC 0.877; 95% CI 0.841–0.913) and extensively drug-resistant (AUC 0.839 0.787–0.892) gram negative pathogens. In addition, external ventricular drainage and intracerebral pressure monitoring catheter were risk factors for XDR. Survival analysis revealed that MDR bacteria colonization happens earlier (log-rank test p = 0.017). Conclusions Optimization of healthcare strategies is required in order to reduce patients’ length of stay to prevent multi- and extensively-drug gram-negative colonizations. Indeed, an early external ventricular drainage and intracerebral pressure monitoring catheter removal is deemed necessary as soon as clinically appropriate. Keywords Extensively drug resistant . Multidrug resistant . Intensive care unit . Infection . Risk factors . Retrospective study
Introduction Patients admitted to intensive care units (ICU) are more exposed to hospital-acquired infections given their critical
This article is part of the Topical Collection on Infection Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-020-04611-3) contains supplementary material, which is available to authorized users. * Alessandro De Cassai [email protected] 1
UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, via Giustiniani 2, 35128 Padua, Italy
2
Department of Medicine-DIMED, University of Padua, Padua, Italy
clinical conditions and the high number o
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