Skip to main content

Is it possible to predict multidrug-resistant organism colonization and/or infection at ICU admission?

Introduction

We tried to develop a predictive model for patients colonized/infected by any multidrug-resistant organism (MDRO-C/I) at ICU admission based on risk factors easy to obtain (not depending on complex clinical records), being aware that foreseeing MDRO-C/I at ICU admission is key for appropriate empirical treatment and infection control.

Methods

Data were collected prospectively from admission to discharge of 16,950 patients admitted consecutively (at least >24 hours) to 147 Spanish ICUs of the ENVIN (National Surveillance Study of Nosocomial Infections in ICUs) registry, from April to June 2010. To create the predictive model, 11,998 (2/3) patients were used for univariable and multivariable logistic regression model and 4,952 (1/3) for subsequent validation.

Results

With a MDRO prevalence of 2.12% (359 MDROs at ICU admission were detected in 314 patients), 87.58% patients had only one MDRO, meanwhile 12.42% were MDRO-C/I by two or more simultaneously. Risk factors used in the development of the predictive model and independently associated with MDRO-C/I at ICU admission were (relative risk not shown due to space limitation): age 65 to 74, medical or surgical critical patient (especially urgent surgery), admitted from other ICU or long-term facility, immunosuppression and deep postsurgical skin or skin-soft tissue infections. Admitted from the community and female gender emerged as protective factors. Although the predictive model showed good discrimination (AUC-ROC = 0.775 (95% CI, 0.744 to 0.807)), sensitivity was only 67.4%. Validation with the remaining 4,952 patients (1/3) showed an AUC-ROC = 0.712 (95% CI, 0.665 to 0.759) and a P value on the Hosmer-Lemeshow goodness of fit test of 0.855. Even creating a new model, including variables obtained after ICU admission (severity by APACHE score, mechanical ventilation, central venous, arterial or urinary catheter, immunodeficiency, parenteral nutrition, ventricular derivation, extrarenal depuration, non-invasive ventilation, tracheotomy, enteral nutrition and nasogastric tube), prediction capability did not improve (AUC-ROC = 0.801 (95% CI, 0.774 to 0.828), sensitivity 71.4%).

Conclusion

MDRO prediction at ICU admission could not be based merely on clinical-demographic risk factors. Taking into account local particularities and combining risk factors with a rapid laboratory test might be the most effective way forward.

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Callejo-Torre, F., Eiros, J., Ossa-Echeverri, S. et al. Is it possible to predict multidrug-resistant organism colonization and/or infection at ICU admission?. Crit Care 19 (Suppl 1), P100 (2015). https://doi.org/10.1186/cc14180

Download citation

  • Published:

  • DOI: https://doi.org/10.1186/cc14180

Keywords

  • Predictive Model
  • Enteral Nutrition
  • Multivariable Logistic Regression Model
  • Apache Score
  • Rapid Laboratory