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Article: Carriage of methicillin-resistant Staphylococcus aureus, ceftazidime-resistant Gram-negative bacilli, and vancomycin-resistant enterococci before and after intensive care unit admission

TitleCarriage of methicillin-resistant Staphylococcus aureus, ceftazidime-resistant Gram-negative bacilli, and vancomycin-resistant enterococci before and after intensive care unit admission
Authors
Issue Date2003
PublisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ccmjournal.org
Citation
Critical Care Medicine, 2003, v. 31 n. 4, p. 1175-1182 How to Cite?
AbstractObjective: To measure patients' risk for acquiring antibiotic-resistant microorganisms associated with intensive care unit admission. Design: Prospective, observational study. Setting: Ten public hospitals including one university medical center. Patients: Consecutive patients admitted to ten intensive care units. Interventions: Serial patient surveillance cultures were screened for vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus (MRSA), ceftazidime-resistant Gram-negative bacilli (CR-GNB), Acute Physiology and Chronic Health Evaluation II score, and antibiotic and medical device exposures. Measurements and Main Results: A total of 1,697 patient admissions in ten intensive care units were enrolled. The overall carriage rate of antibiotic-resistant bacteria at intensive care unit entry was 12.1% for MRSA, 14% for CR-GNB and 4.7% for both. At discharge from the intensive care unit, new carriage of MRSA, CR-GNB, and both was found in 11.1%, 14.2%, and 2.4% of the patients, respectively. The acquisition rates in the individual units correlated highly and positively with proportion of patients with carriage at intensive care unit entry for both MRSA (n = 10, Pearson's r = .89, p < 0.001) and CR-GNB (n = 10, Pearson's r = .92, p < 0.001). By logistic regression, severity of illness (odds ratio, 1.4), length of stay (odds ratio, 1.7), use of penicillins (odds ratio, 1.9), and number of antibiotics (odds ratio, 1.2) and medical devices (odds ratio, 1.2) were independently associated with intensive care unit acquisition of MRSA. In comparison, variables independently associated with intensive care unit acquisition of CR-GNB were Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.5), number of antibiotics (odds ratio, 1.1), and artificial airway (odds ratio, 1.5). Conclusions: These data suggest that hospitalization in the intensive care unit introduces significant risk to patients in terms of transmission of MRSA and/or CR-GNB. This risk seems to be influenced strongly by the proportion of patients with colonization at intensive care unit admission and is associated with severity of illness, length of stay, and exposures to antibiotics and medical devices.
Persistent Identifierhttp://hdl.handle.net/10722/79213
ISSN
2015 Impact Factor: 7.422
2015 SCImago Journal Rankings: 3.748
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorHo, PLen_HK
dc.date.accessioned2010-09-06T07:51:58Z-
dc.date.available2010-09-06T07:51:58Z-
dc.date.issued2003en_HK
dc.identifier.citationCritical Care Medicine, 2003, v. 31 n. 4, p. 1175-1182en_HK
dc.identifier.issn0090-3493en_HK
dc.identifier.urihttp://hdl.handle.net/10722/79213-
dc.description.abstractObjective: To measure patients' risk for acquiring antibiotic-resistant microorganisms associated with intensive care unit admission. Design: Prospective, observational study. Setting: Ten public hospitals including one university medical center. Patients: Consecutive patients admitted to ten intensive care units. Interventions: Serial patient surveillance cultures were screened for vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus (MRSA), ceftazidime-resistant Gram-negative bacilli (CR-GNB), Acute Physiology and Chronic Health Evaluation II score, and antibiotic and medical device exposures. Measurements and Main Results: A total of 1,697 patient admissions in ten intensive care units were enrolled. The overall carriage rate of antibiotic-resistant bacteria at intensive care unit entry was 12.1% for MRSA, 14% for CR-GNB and 4.7% for both. At discharge from the intensive care unit, new carriage of MRSA, CR-GNB, and both was found in 11.1%, 14.2%, and 2.4% of the patients, respectively. The acquisition rates in the individual units correlated highly and positively with proportion of patients with carriage at intensive care unit entry for both MRSA (n = 10, Pearson's r = .89, p < 0.001) and CR-GNB (n = 10, Pearson's r = .92, p < 0.001). By logistic regression, severity of illness (odds ratio, 1.4), length of stay (odds ratio, 1.7), use of penicillins (odds ratio, 1.9), and number of antibiotics (odds ratio, 1.2) and medical devices (odds ratio, 1.2) were independently associated with intensive care unit acquisition of MRSA. In comparison, variables independently associated with intensive care unit acquisition of CR-GNB were Acute Physiology and Chronic Health Evaluation II score (odds ratio, 1.5), number of antibiotics (odds ratio, 1.1), and artificial airway (odds ratio, 1.5). Conclusions: These data suggest that hospitalization in the intensive care unit introduces significant risk to patients in terms of transmission of MRSA and/or CR-GNB. This risk seems to be influenced strongly by the proportion of patients with colonization at intensive care unit admission and is associated with severity of illness, length of stay, and exposures to antibiotics and medical devices.en_HK
dc.languageengen_HK
dc.publisherLippincott Williams & Wilkins. The Journal's web site is located at http://www.ccmjournal.orgen_HK
dc.relation.ispartofCritical Care Medicineen_HK
dc.rightsCritical Care Medicine. Copyright © Lippincott Williams & Wilkins.en_HK
dc.subject.meshAgeden_HK
dc.subject.meshCarrier State - microbiologyen_HK
dc.subject.meshCeftazidime - pharmacologyen_HK
dc.subject.meshCephalosporin Resistanceen_HK
dc.subject.meshDrug Resistance, Bacterialen_HK
dc.subject.meshEnterobacteriaceae - drug effects - isolation & purificationen_HK
dc.subject.meshEnterococcus - drug effects - isolation & purificationen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshGram-Negative Bacteria - drug effects - isolation & purificationen_HK
dc.subject.meshHumansen_HK
dc.subject.meshIntensive Care Unitsen_HK
dc.subject.meshLength of Stayen_HK
dc.subject.meshLogistic Modelsen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMethicillin Resistanceen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshPatient Admissionen_HK
dc.subject.meshPatient Dischargeen_HK
dc.subject.meshRisk Factorsen_HK
dc.subject.meshStaphylococcus aureus - drug effects - isolation & purificationen_HK
dc.subject.meshVancomycin Resistanceen_HK
dc.titleCarriage of methicillin-resistant Staphylococcus aureus, ceftazidime-resistant Gram-negative bacilli, and vancomycin-resistant enterococci before and after intensive care unit admissionen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0090-3493&volume=31&issue=4&spage=1175&epage=82&date=2003&atitle=Carriage+of+methicillin-resistant+Staphylococcus+aureus,+ceftazidime-resistant+Gram-negative+bacilli,+and+vancomycin-resistant+enterococci+before+and+after+intensive+care+unit+admissionen_HK
dc.identifier.emailHo, PL:plho@hkucc.hku.hken_HK
dc.identifier.authorityHo, PL=rp00406en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1097/01.CCM.0000059437.01924.97en_HK
dc.identifier.pmid12682490-
dc.identifier.scopuseid_2-s2.0-0037390788en_HK
dc.identifier.hkuros83451en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0037390788&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume31en_HK
dc.identifier.issue4en_HK
dc.identifier.spage1175en_HK
dc.identifier.epage1182en_HK
dc.identifier.isiWOS:000182411900028-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridHo, PL=7402211363en_HK

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