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Impact of Antibiotic-Resistant Pathogens Colonizing the Respiratory Secretions of Patients in an Extended-Care Area of the Emergency Department

Published online by Cambridge University Press:  02 January 2015

Sônia R. P. E. Dantas  and
M. Luiza Moretti-Branchini
Sônia R. P. E. Dantas
Affiliation:
Hospital Infection Control Committee, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
M. Luiza Moretti-Branchini*
Affiliation:
Infectious Diseases Division, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
*
Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP), Rua Vital Brasil, 251, Cidade Universitária Zeferino Vaz, CEP 13.083-970, Campinas, São Paulo, Brazil
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Abstract

Objective:

To determine the incidence of acquired infection, and the incidence, risk factors, and molecular typing of multidrug-resistant bacterial organisms (MROs) colonizing respiratory secretions or the oropharynx of patients in an extended-care area of the emergency department (ED) in a tertiary-care university hospital.

Methods:

A case-control study was conducted regarding risk factors for colonization with MROs in ED patients from July 1996 to August 1998. The most prevalent MRO strains were determined using plasmid and genomic analysis with PFGE.

Results:

MROs colonized 59 (25.4%) of 232 ED patients and 173 controls. The mean ED length of stay for the 59 cases was 13.9 days versus 9.8 days for the 173 controls. The mean length of stay prior to the first isolation of MROs was 9.9 days. MRO species included Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa. The rate of hospital-acquired infection was 32.7 per 1,000 ED patient-days. The case fatality rate was significantly higher for cases. Univariate analysis identified mechanical ventilation, nebulization, nasogastric intubation, urinary catheterization, antibiotic therapy, and number of antibiotics as risk factors for MRO colonization. Multivariate regression analysis found that mechanical ventilation and nasogastric intubation independently predicted MRO colonization. Endemic clones were identified by PFGE in ED patients and were also found in patients in other parts of the hospital.

Conclusions:

Prolonged stay in the ED posed a risk for colonization with MROs and for contracting nosocomial infections, both of which were associated with increased mortality. Patients colonized with antibiotic-resistant A. baumannii may serve as a reservoir for spread in this hospital.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 5 , May 2003 , pp. 351 - 355
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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