Risk factors for multi-resistant organisms in sepsis
© Serpa-Pinto and Cardoso; licensee BioMed Central Ltd. 2014
Published: 17 March 2014
The increasing prevalence of infections by multi-resistant organisms (MDR) has increased over the last decades, with implications not only in the overall level of therapeutic success, but also in the selective pressure exerted by the use of broad-spectrum antibiotics to defeat increasingly resistant agents, thereby creating a vicious cycle . The aim of this study is to describe risk factors associated with infection by MDR organisms among septic patients.
A retrospective cohort study including all adult patients with microbiological documented sepsis, admitted to the emergency room of a tertiary care, university hospital between 1 July 2011 and 30 June 2012.
During the study period, 162 patients were admitted to the emergency room with severe sepsis; 79 (49%) had microbiological documentation, and were included in this study. The mean (SD) age was 71 (15) years; 62% were men. Forty patients (51%) had an infection by a MDR organism. Risk factors associated with infection by a MDR organism were the presence of any comorbidity (OR = 3.542, P = 0.022), diabetes mellitus (OR = 4.500, P = 0.006), Karnofsky performance status (KPS) <70% (OR = 3.882, P = 0.005), the presence of modifiers of etiology (OR = 5,040, P = 0.010), chronic wounds (OR = 5.371, P = 0.040), healthcare-associated infections (OR = 3.325, P = 0.026) and hospital- acquired infections (OR = 5.225, P = 0.016). The multivariate model retained as independent variables associated with infection by a MDR organism: the presence of diabetes mellitus (adjusted OR = 4.1,95% CI: 1.4 to 12.6) and the need for assistance in daily activities (KPS <70%, adjusted OR = 3.6, 95% CI: 1.3 to 9.7).
The presence of diabetes and decreased functional capacity should be considered risk factors for infection by a MDR organism and should be taken into consideration in the empirical therapy prescription.
This article is published under license to BioMed Central Ltd. This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2014 and co-published as a series in Critical Care. Other articles in the series can be found online at http://ccforum.com/series/annualupdate2014. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.