Main Organiser

Julius Centre University of Malaya

Co-organiser

Department of Social and Preventive Medicine, Faculty of Medicine, University of Malay

Supported by

University of Malaya

RISK FACTORS FOR RESISTANT GRAM NEGATIVE BACILLI AMONG THE CRITICALLY ILL PATIENTS

Author

Vasudevan A, Mukhopadhyay A, Eugene GYY, Tambyah PA

Institution

National University Health System

Abstract

Objectives: To identify risk factors associated with multi-resistant gram negative (RGNB) infection and colonization among critically ill patients.

Methods: In this prospective cohort study, all patients aged 21-90 admitted for more than 24hours in Medical and Surgical ICUs of a large teaching hospital in Singapore were included. Patient demographics, comorbidities, antibiotics, invasive devices, culture results were collected. Multivariable analyses were done to identify risk factors associated with RGNB infection and colonization.

Results: Of the 1633 patients included in our study from Medical and Surgical ICU for the period of Aug’07 to December’09, 1373 were included in the analysis. A logistic regression analysis including variables with a p value of <0.2 in the univariate analysis showed that surgery (OR2.1, 95%CI 1.2- 3.6), renal impairment (OR2.9, 95%CI 1.5-5.4), liver disease (OR:3.8, 95%CI 1.7-8.8), central line (OR1.8, 95%CI 1.01-3.4) were independently associated with RGNB infection in the ICU. Surgery (OR3.9, 95%CI 2.7-5.7), broad spectrum antibiotics (OR1.8, 95%CI 1.2-2.9) were independently associated with RGNB infection during their subsequent hospital stay. The same factors were associated with the acquisition of RGNB colonization.

Conclusion: The risk factors associated with RGNB in ICU were mostly patient related. This study has reiterated that initial broad spectrum antibiotics usage contributes to the occurrence of resistant organism. This is an important target for intervention in these vulnerable patients.