Intensive Care Unit, Cayenne General Hospital, Cayenne, French Guiana.
Tropical Biome and Immunophysiopathology (TBIP), Universite de Guyane, Cayenne, French Guiana.
Am J Trop Med Hyg. 2022 Jan 10;106(2):525-531. doi: 10.4269/ajtmh.20-1436.
Intensive care unit-acquired infection (ICU-AI) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) carriage are a major concern worldwide. Our objective was to investigate the impact of ESBL-PE carriage on ICU-AI. Our study was prospective, observational, and noninterventional. It was conducted over a 5-year period (Jan 2013-Dec 2017) in the medical-surgical intensive care unit of the Cayenne General Hospital (French Amazonia). During the study period, 1,340 patients were included, 271 (20.2%) developed ICU-AI, and 16.2% of these were caused by ESBL-PE. The main sites of ICU-AI were ventilator-associated pneumonia (35.8%) and primary bloodstream infection (29.8%). The main responsible microorganisms were Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae (ESBL-P in 35.8% of isolates), and Enterobacter cloacae (ESBL-P in 29.8% of isolates). Prior ESBL-PE carriage was diagnosed in 27.6% of patients with ICU-AI. In multivariable analysis, the sole factor associated with ESBL-PE as the responsible organism of ICU-AI was ESBL-PE carriage before ICU-AI (P < 0.001; odds ratio: 7.9 95% CI: 3.4-18.9). ESBL-PE carriers (74 patients) developed ICU-AI which was caused by ESBL-PE in 32 cases (43.2%). This proportion of patients carrying ESBL-PE who developed ICU-AI to the same microorganism was 51.2% in ESBL-P K. pneumoniae, 5.6% in ESBL-P Escherichia coli, and 40% in ESBL-P Enterobacter spp. NPV of ESBL-PE carriage to predict ICU-AI caused by ESBL-PE was above 94% and PPV was above 43%. Carriage of ESBL-P K pneumoniae and Enterobacter spp. is a strong predictor of ICU-AI caused by these two microorganisms.
重症监护病房获得性感染（ICU-AI）和产超广谱β-内酰胺酶肠杆菌科（ESBL-PE）定植是全球关注的主要问题。我们的目的是研究 ESBL-PE 定植对 ICU-AI 的影响。我们的研究是前瞻性、观察性和非干预性的。它在卡宴综合医院（法属亚马逊地区）的内科-外科重症监护病房进行了 5 年（2013 年 1 月至 2017 年 12 月）。在研究期间，纳入了 1340 名患者，其中 271 名（20.2%）发生 ICU-AI，其中 16.2%是由 ESBL-PE 引起的。ICU-AI 的主要部位是呼吸机相关性肺炎（35.8%）和原发性血流感染（29.8%）。主要的致病微生物是金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌（ESBL-P 在 35.8%的分离株中）和阴沟肠杆菌（ESBL-P 在 29.8%的分离株中）。在 27.6%的 ICU-AI 患者中诊断出先前存在 ESBL-PE 定植。在多变量分析中，唯一与 ESBL-PE 作为 ICU-AI 致病微生物相关的因素是 ICU-AI 前 ESBL-PE 定植（P < 0.001；优势比：7.995%CI：3.4-18.9）。ESBL-PE 携带者（74 名患者）发生了 ICU-AI，其中 32 例（43.2%）由 ESBL-PE 引起。携带 ESBL-PE 的患者发展为相同微生物引起的 ICU-AI 的比例为 ESBL-P K. pneumoniae 51.2%、ESBL-P Escherichia coli 5.6%和 ESBL-P Enterobacter spp. 40%。ESBL-PE 定植预测 ESBL-PE 引起的 ICU-AI 的阴性预测值（NPV）大于 94%，阳性预测值（PPV）大于 43%。ESBL-P K pneumoniae 和 Enterobacter spp. 的定植是这两种微生物引起的 ICU-AI 的强预测因素。
