scholarly journals Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit

2006 ◽  
Vol 27 (10) ◽  
pp. 1032-1040 ◽  
Author(s):  
David K. Warren ◽  
Rebecca M. Guth ◽  
Craig M. Coopersmith ◽  
Liana R. Merz ◽  
Jeanne E. Zack ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Active Surveillance ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Icu Admission ◽  
The Past ◽  
Surgical Icu ◽  
Mrsa Colonization

Background.Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of healthcare-associated infections among surgical intensive care unit (ICU) patients, though transmission dynamics are unclear.Objective.To determine the prevalence of MRSA nasal colonization at ICU admission, to identify associated independent risk factors, to determine the value of these factors in active surveillance, and to determine the incidence of and risk factors associated with MRSA acquisition.Design.Prospective cohort study.Setting.Surgical ICU at a teaching hospital.Patients.All patients admitted to the surgical ICU.Results.Active surveillance for MRSA by nasal culture was performed at ICU admission during a 15-month period. Patients who stayed in the ICU for more than 48 hours had nasal cultures performed weekly and at discharge from the ICU, and clinical data were collected prospectively. Of 1,469 patients, 122 (8%) were colonized with MRSA at admission; 75 (61%) were identified by surveillance alone. Among 775 patients who stayed in the ICU for more than 48 hours, risk factors for MRSA colonization at admission included the following: hospital admission in the past year (1-2 admissions: adjusted odds ratio [aOR], 2.60 [95% confidence interval {CI}, 1.47-4.60]; more than 2 admissions: aOR, 3.56 [95% CI, 1.72-7.40]), a hospital stay of 5 days or more prior to ICU admission (aOR, 2.54 [95% CI, 1.49-4.32]), chronic obstructive pulmonary disease (aOR, 2.16 [95% CI, 1.17-3.96]), diabetes mellitus (aOR, 1.87 [95% CI, 1.10-3.19]), and isolation of MRSA in the past 6 months (aOR, 8.18 [95% CI, 3.38-19.79]). Sixty-nine (10%) of 670 initially MRSA-negative patients acquired MRSA in the ICU (corresponding to 10.7 cases per 1,000 ICU-days at risk). Risk factors for MRSA acquisition included tracheostomy in the ICU (aOR, 2.18 [95% CI, 1.13-4.20]); decubitus ulcer (aOR, 1.72 [95% CI, 0.97-3.06]), and receipt of enteral nutrition via nasoenteric tube (aOR, 3.73 [95% CI, 1.86-7.51]), percutaneous tube (aOR, 2.35 [95% CI, 0.74-7.49]), or both (aOR, 3.33 [95% CI, 1.13-9.77]).Conclusions.Active surveillance detected a sizable proportion of MRSA-colonized patients not identified by clinical culture. MRSA colonization on admission was associated with recent healthcare contact and underlying disease. Acquisition was associated with potentially modifiable processes of care.

scholarly journals Risk Factors and Outcomes Associated with Multidrug-Resistant Acinetobacter baumannii upon Intensive Care Unit Admission

2017 ◽  
Vol 62 (1) ◽  
Author(s):  
Natalia Blanco ◽  
Anthony D. Harris ◽  
Clare Rock ◽  
J. Kristie Johnson ◽  
Lisa Pineles ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Acinetobacter Baumannii ◽  
Cohort Analysis ◽  
Multidrug Resistant ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Content Type ◽  
Icu Admission

ABSTRACT Multidrug-resistant (MDR) Acinetobacter baumannii, associated with broad-spectrum antibiotic use, is an important nosocomial pathogen associated with morbidity and mortality. This study aimed to investigate the prevalence of MDR A. baumannii perirectal colonization among adult patients upon admission to the intensive care unit (ICU) over a 5-year period and to identify risk factors and outcomes associated with colonization. A retrospective cohort analysis of patients admitted to the medical intensive care unit (MICU) and surgical intensive care unit (SICU) at the University of Maryland Medical Center from May 2005 to September 2009 was performed using perirectal surveillance cultures on admission. Poisson and logistic models were performed to identify associated risk factors and outcomes. Four percent of the cohort were positive for MDR A. baumannii at ICU admission. Among patients admitted to the MICU, those positive for MDR A. baumannii at admission were more likely to be older, to have received antibiotics before ICU admission, and to have shorter length of stay in the hospital prior to ICU admission. Among patients admitted to the SICU, those colonized were more likely to have at least one previous admission to our hospital. Patients positive for MDR A. baumannii at ICU admission were 15.2 times more likely to develop a subsequent positive clinical culture for A. baumannii and 1.4 times more likely to die during the current hospitalization. Risk factors associated with MDR A. baumannii colonization differ by ICU type. Colonization acts as a marker of disease severity and of risk of developing a subsequent Acinetobacter infection and of dying during hospitalization. Therefore, active surveillance could guide empirical antibiotic selection and inform infection control practices.

scholarly journals Pseudomonas aeruginosa Colonization in the Intensive Care Unit: Prevalence, Risk Factors, and Clinical Outcomes

2016 ◽  
Vol 37 (5) ◽  
pp. 544-548 ◽  
Author(s):  
Anthony D. Harris ◽  
Sarah S. Jackson ◽  
Gwen Robinson ◽  
Lisa Pineles ◽  
Surbhi Leekha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Icu Admission ◽  
Clinical Culture ◽  
Culture Positive

OBJECTIVETo determine the prevalence of Pseudomonas aeruginosa colonization on intensive care unit (ICU) admission, risk factors for P. aeruginosa colonization, and the incidence of subsequent clinical culture with P. aeruginosa among those colonized and not colonized.METHODSWe conducted a cohort study of patients admitted to a medical or surgical intensive care unit of a tertiary care hospital. Patients had admission perirectal surveillance cultures performed. Risk factors analyzed included comorbidities at admission, age, sex, antibiotics received during current hospitalization before ICU admission, and type of ICU.RESULTSOf 1,840 patients, 213 (11.6%) were colonized with P. aeruginosa on ICU admission. Significant risk factors in the multivariable analysis for colonization were age (odds ratio, 1.02 [95% CI, 1.01–1.03]), anemia (1.90 [1.05–3.42]), and neurologic disorder (1.80 [1.27–2.54]). Of the 213 patients colonized with P. aeruginosa on admission, 41 (19.2%) had a subsequent clinical culture positive for P. aeruginosa on ICU admission and 60 (28.2%) had a subsequent clinical culture positive for P. aeruginosa in the current hospitalization (ICU period and post-ICU period). Of these 60 patients, 49 (81.7%) had clinical infections. Of the 1,627 patients not colonized on admission, only 68 (4.2%) had a subsequent clinical culture positive for P. aeruginosa in the current hospitalization. Patients colonized with P. aeruginosa were more likely to have a subsequent positive clinical culture than patients not colonized (incidence rate ratio, 6.74 [95% CI, 4.91–9.25]).CONCLUSIONSPrediction rules or rapid diagnostic testing will help clinicians more appropriately choose empirical antibiotic therapy for subsequent infections.Infect Control Hosp Epidemiol 2016;37:544–548

Risk Factors for Pressure Ulcer Development in a Best Practice Surgical Intensive Care Unit

2007 ◽  
Vol 73 (12) ◽  
pp. 1215-1217 ◽  
Author(s):  
Heidi Frankel ◽  
Jason Sperry ◽  
Lewis Kaplan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Intensive Care ◽  
Pressure Ulcers ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Cord Injury ◽  
Surgical Icu

We describe the incidence of and define risk factors for pressure ulcers (PU) in the surgical intensive care unit (ICU). Twelve months of data were collected on all patients admitted to the intensivist-run surgical ICU of a university hospital. PU patients were those who developed a new stage II or greater lesion during or after a surgical ICU stay as identified in Project Impact®, ICD9 discharge, or ICU complications databases. Patients were nursed in pressure-relieving beds with nutrition initiated by 72 hours. χ2, t test, and logistic regression statistics were used. Three percent (25/820) developed PU. Age, ICU length of stay, Acute Physiology and Chronic Health Evaluation Score (APACHE), and gender were not different between those with and without PU. Patients with PU had a higher blood urea nitrogen/creatinine (30.5/2.2 mg/dL vs 22.0/1.6 mg/dL) and were more frequently vascular patients (28 vs 14.1%), diabetics (40 vs 17.2%), paraplegics (8 vs 0.2%) (all P < 0.01), and patients on pressors (28.0 vs 11.8%, P < 0.02). Multivariate analysis revealed that diabetes (odds ratio [OR] 2.7, 95%, confidence interval [CI] 1.1-6.4), spinal cord injury (OR 16.8, 95%, CI 1.5-183), age > 60 years (OR 2.9,95%, CI 1.2-7.1), and a creatinine >3 mg/dL (OR 3.7,95%, CI 1.2-9.3) were independent predictors of PU. Despite universal use of specialty beds and early nutrition, pressure ulcers developed in 3 per cent. Independent risk factors include age greater than 60 years, diabetes, spinal cord injury, and renal insufficiency. Additional modalities, such as aggressive early mobilization, might be warranted in this cohort.

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