DOI: 10.1128/AAC.00341-18
Article Figures & Data
Figures
- FIG 1
Flowchart of patients included in this study. CR-GNB, carbapenem-resistant Gram-negative bacteria; ICU, intensive care unit; BUH, Buddhachinaraj Hospital; NUH, Naresuan University Hospital.
Tables
- TABLE 1
Factors associated with intestinal colonization of CR-GNB among ICU patientse
Characteristic No. (%) of patients in the following groups with the indicated characteristic: Univariate analysis P value Multivariate logistic regression analysis All patients (n = 275) CR-GNB carriers (n = 32) Non-CR-GNB carriers (n = 243) P valuea aOR (95% CI) Male patients 149 (54.2) 14 (43.8) 135 (55.6) 0.199 Age >65 yr 119 (43.3) 16 (50.0) 103 (42.4) 0.497 Secondary school educationb 190 (69.1) 19 (59.4) 171 (70.4) 0.174 ≥5 family membersc 52 (18.9) 4 (12.5) 48 (19.8) 0.381 Family income of <10,000 bahtd 168 (61.1) 18 (56.3) 150 (61.7) 0.405 Urban living 85 (30.9) 11 (34.4) 74 (30.5) 0.520 Antibiotic usage within previous 3 mo 93 (33.8) 17 (53.1) 76 (31.3) 0.017 0.278 1.614 (0.679–3.836) Hospitalization within previous 6 mo 89 (32.4) 19 (59.4) 70 (28.8) 0.001 0.002 3.818 (1.642–8.878) Referral of patients from: Home 99 (36.0) 10 (31.3) 89 (36.6) 0.722 Another hospital 73 (26.5) 7 (21.9) 66 (27.2) 0.654 Another ward within hospital 92 (33.5) 12 (37.5) 80 (32.9) 0.434 Principle diagnosis Respiratory tract disease 69 (25.1) 13 (40.6) 56 (23.0) 0.034 0.051 2.309 (0.996–5.353) Cardiovascular disease 35 (12.7) 6 (18.8) 29 (11.9) 0.271 Renal disease 19 (6.9) 3 (9.4) 16 (6.6) 0.477 Sepsis 41 (14.9) 4 (12.5) 37 (15.2) 0.797 Underlying condition Cardiovascular disease 130 (47.3) 14 (43.8) 116 (47.7) 0.665 Diabetes 71 (25.8) 11 (34.4) 60 (24.7) 0.233 Respiratory tract disease 35 (12.7) 6 (18.8) 29 (11.9) 0.264 Renal disease 38 (13.8) 5 (15.6) 33 (13.6) 0.784 Liver disease 18 (6.5) 1 (3.1) 17 (7.0) 0.704 Length of ICU stay (day) <8 days 165 (60.0) 17 (53.1) 148 (60.9) 0.274 8–14 days 51 (14.5) 7 (21.9) 44 (18.1) 0.666 15–21 days 29 (10.5) 5 (15.6) 24 (9.9) 0.362 >21 days 14 (5.1) 2 (6.3) 12 (4.9) 0.678 30-day mortality 35 (12.7) 4 (12.5) 31 (12.8) 1.000 ↵a A P value of <0.05 was considered statistically significant.
↵b Basic education in Thailand consists of 6 years of primary school education and 6 years of secondary school education.
↵c Average number of household members.
↵d The average minimum income per month is 10,000 baht.
↵e Data are for a total of 275 patients.
- TABLE 2
Distribution of CR-GNB isolates and types of carbapenemase genes among CR-GNB in carriage and acquisition groups
Organism No. (%) of isolates No. of isolates carrying the following carbapenemase gene: blaIMP blaNDM blaOXA-23 blaOXA-24 blaOXA-51 blaOXA-58 blaOXA-23/51 blaOXA-51/58 blaOXA-23/51/58 blaOXA-24/51/58 CR-GNB carriage isolates 37 A. baumannii 15 (40.5) 1 1 2 1 2 5 1 3 K. pneumoniae 9 (24.3) 6 Acinetobacter spp. 5 (13.5) 1 1 Enterobacter spp. 3 (8.1) 2 Other CR-GNBa 5 (13.5) CR-GNB acquisition isolates 59 A. baumannii 28 (47.5) 4 15 3 2 1 K. pneumoniae 13 (22.0) 9 Acinetobacter spp. 7 (11.9) 2 1 1 P. aeruginosa 5 (8.5) 3 Enterobacter spp. 1 (1.7) 1 Klebsiella spp. 1 (1.7) 1 Other CR-GNBb 4 (6.8) - TABLE 3
Factors associated with acquisition of CR-GNB among patients during ICU stayc
Characteristic No. (%) of patients in the following groups with the indicated characteristic: Univariate analysis P value Multivariate logistic regression analysis All patients (n = 206) CR-GNB acquisition (n = 52) Non-CR-GNB acquisition (n = 154) P valuea aOR (95% CI) Male gender 113 (54.9) 30 (57.7) 83 (53.9) 0.540 Age >65 yr 84 (40.8) 23 (44.2) 61 (39.6) 0.486 Mechanical devices Central venous catheter 29 (14.1) 8 (15.4) 21 (13.6) 0.690 Indwelling urinary catheter 168 (81.6) 43 (82.7) 125 (81.2) 0.485 Enteral feeding tube 153 (74.3) 46 (88.5) 107 (69.5) 0.002 0.008 5.386 (1.563–18.564) Endotracheal tube 159 (77.2) 46 (88.5) 113 (73.4) 0.007 0.729 0.763 (0.165–3.527) Antibiotic usage during ICU stay First- and second-generation cephalosporins 35 (17.0) 6 (11.5) 29 (18.8) 0.258 Third-generation cephalosporins 121 (58.7) 37 (71.2) 84 (54.5) 0.017 0.032 2.293 (1.074–4.896) Carbapenems 42 (20.4) 16 (30.8) 26 (16.9) 0.023 0.045 2.199 (1.019–4.743) Penicillinsb 4 (1.9) 2 (3.8) 2 (1.3) 0.254 β-Lactam–β-lactamase inhibitors 36 (17.5) 10 (19.2) 26 (16.9) 0.629 Aminoglycosidesb 2 (1.0) 1 (1.9) 1 (0.6) 0.433 Fluoroquinolones 18 (8.7) 7 (13.5) 11 (7.1) 0.156 Macrolides 26 (12.6) 8 (15.4) 18 (11.7) 0.437 Colistinb 7 (3.4) 2 (3.8) 5 (3.2) 0.682 Vancomycin 11 (5.3) 4 (7.7) 7 (4.5) 0.470 Clindamycin 21 (10.2) 4 (7.7) 17 (11.0) 0.531 Metronidazole 12 (5.8) 5 (9.6) 7 (4.5) 0.174 Fosfomycinb 2 (1.0) 1 (1.9) 1 (0.6) 0.433 Underlying conditions Cardiovascular disease 97 (47.1) 23 (44.2) 74 (48.1) 0.870 Respiratory disease 25 (12.1) 7 (13.5) 18 (11.7) 0.635 Renal disease 24 (11.7) 8 (15.4) 16 (10.4) 0.264 Diabetes 52 (25.2) 14 (26.9) 38 (24.7) 0.592 Liver disease 14 (6.8) 2 (3.8) 12 (7.8) 0.524 Length of ICU stay (day) <8 days 129 (62.6) 24 (46.2) 105 (68.2) 0.008 0.498 0.730 (0.293–1.815) 8–14 days 34 (16.5) 10 (19.2) 24 (15.6) 0.449 15–21 days 22 (10.7) 9 (17.3) 13 (8.4) 0.055 0.131 2.144 (0.797–5.767) >21 days 8 (3.9) 4 (7.7) 4 (2.6) 0.100 0.149 3.227 (0.657–15.860) 30-day mortality 16 (7.8) 5 (9.6) 11 (7.1) 0.553
Supplemental material
- Supplemental file 1 -
Supplemental Figures S1 and S2 and Table S1
PDF, 498K
- Supplemental file 1 -
