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Risk factors for multi-resistant organisms in sepsis

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Introduction

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 [1][2]. The aim of this study is to describe risk factors associated with infection by MDR organisms among septic patients.

Methods

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.

Results

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).

Conclusion

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.

References

  1. 1.

    Siegel JD, et al: Am J Infect Control. 2007, 35 (10 Suppl 2): S165-S193.

  2. 2.

    Wright SW, et al: Am J Emerg Med. 2000, 18: 143-146. 10.1016/S0735-6757(00)90005-6.

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Author information

Correspondence to L Serpa-Pinto.

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Serpa-Pinto, L., Cardoso, T. Risk factors for multi-resistant organisms in sepsis. Crit Care 18, P342 (2014). https://doi.org/10.1186/cc13532

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Keywords

  • Diabetes Mellitus
  • Emergency Room
  • Severe Sepsis
  • Functional Capacity
  • Retrospective Cohort Study