Incidence, impact and risk factors for multidrug-resistant organisms (MDRO) in patients with major trauma: a European Mu
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ORIGINAL ARTICLE
Incidence, impact and risk factors for multidrug‑resistant organisms (MDRO) in patients with major trauma: a European Multicenter Cohort Study André Nohl1,7 · Uwe Hamsen2 · Kai Oliver Jensen3 · Kai Sprengel3 · Franziska Ziegenhain3 · Rolf Lefering5 · Marcel Dudda1,4 · Thomas Armin Schildhauer2 · Alexander Wegner6 Received: 13 July 2020 / Accepted: 2 November 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction The burden of MDRO in health systems is a global issue, and a growing problem. We conducted a European multicenter cohort study to assess the incidence, impact and risk factors for multidrug-resistant organisms in patients with major trauma. We conducted this study because the predictive factors and effects of MDRO in severely injured patients are not yet described. Our hypothesis is that positive detection of MDRO in severely injured patients is associated with a less favorable outcome. Methods Retrospective study of four level-1 trauma centers including all patients after major trauma with an injury severity score (ISS) ≥ 9 admitted to an intensive care unit (ICU) between 2013 and 2017. Outcome was measured using the Glasgow outcome scale (GOS). Results Of 4131 included patients, 95 (2.3%) had a positive screening for MDRO. Risk factors for MDRO were male gender (OR 1.73 [95% CI 1.04–2.89]), ISS (OR 1.01 [95% CI 1.00–1.03]), PRBC’s given (OR 1.73 [95% CI 1.09–2.78]), ICU stay > 48 h (OR 4.01 [95% CI 2.06–7.81]) and mechanical ventilation (OR 1.85 [95% CI 1.01–3.38]). A positive MDRO infection correlates with worse outcome. MDRO positive cases GOS: good recovery = 0.6%, moderate disability = 2.1%, severe disability = 5.6%, vegetative state = 5.7% (p 48 h, multiorgan failure, sepsis and a worse outcome were associated with a positive MDRO screening. The association between MDRO-positive and duration of ICU stay in days, mechanical ventilation in hours, and hospital stay in days is shown in Table 3. No correlation was found between MDRO-positive and negative for death (correlation coefficient − 0.017, p = 0.28). In 11 cases a positive result for MDRO could be proven on the basis of the patient file. However, due to paper files
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Table 1 Localization and classification of MDRO Localisation, n (%) Urinary tract Pulmonary tract Wounds Nose/throat Skin Rectal Missing Microorganism, n (%) Klebsiella pneumoniae Staphylococcus aureus Pseudomonas aeroginosa E. coli Acinetobacter baumanii Enterococcus spp. Enterobacter spp. Others Missing Type, n (%) MRSA MDR-GNB VRE ESBL
11 (11.6) 14 (14.7) 12 (12.6) 15 (15.8) 14 (14.7) 2 (2.1) 3 (3.2) 8 (8.4) 24 (25.3) 16 (16.8) 14 (14.7) 3 (3.2) 8 (8.4) 6 (6.3) 5 (5.3) 11 (11.6) 29 (30.5) 49 (51.6) 7 (7.4) 12 (12.6)
and incomplete reports, the exact name of the microorganism could not be found.
Multivariate predictors for MDRO Table 4 shows the predictive variables. Male gender, ISS, PRBC given, ICU stay > 48 h and mechanical ventilation were significantly predictive for MDRO in o
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