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Colonization and infection by potential Gram-negative multiresistant microorganism in a medical–surgical ICU

Introduction

To determine the rate of colonization/infection by potential Gram-negative multiresistant microorganisms (pseudomonas, stenotrophomonas and acinetobacter) in critically ill patients.

Methods

A prospective study for 30 months in the ICU. Throat swabs, tracheal aspirates and urine were taken on admission and twice weekly. The infections were classified based on thorat flora as: primary endogenous (PE), caused by germs that were already colonizing the throat on ICU admission; secondary endogenous (SE), caused by germs that were not colonizing the throat on ICU admission but were acquired during the stay in the ICU; and exogenous (EX), caused by germs that were not colonizing the throat. The infections were classified based on the onset as: early onset (EO), when developed during the first 4 days of ICU stay; and late onset (LO), when developed 5 days after ICU admission.

Results

In total 1,582 patients were admitted. The mean APACHE II score was 13.95 (± 8.93). Mortality was 14.79%. A total of 80 patients had colonization by pseudomonas, 26 patients at ICU admission and 54 patients during the ICU stay. We documented 46 infections by pseudomonas (nine EO and 37 LO; four PE, 35 SE and seven EX) with death in 13/46 patients (28.26%): 31 pneumonias (six EO and 25 LO; two PE, 24 SE and five EX), seven urinary tract infections (one EO and six LO; two PE, three SE and two EX), five primary bacteremias (two EO and three LO; five SE), two surgical wound infections (two LO and SE) and one pressure sore infection (one LO and SE). A total of 14 patients had colonization by stenotrophomonas, one patient at ICU admission and 13 patients during the ICU stay. We documented eight infections by stenotrophomonas (two EO and six LO; seven SE and one EX) with death in 3/8 patients (37.50%): all were pneumonias. A total of 12 patients had colonization by acinetobacter, one patient at ICU admission and 11 patients during the ICU stay. We documented eight infections by acinetobacter (two EO and six LO; seven ES and one EX) with death in 2/8 patients (25%): six pneumonias (two EO and four LO; five SE and one EX) and two bloodstream infection (two LO and two SE).

Conclusion

In our series, most of the infections caused by pseudomona, stenotrophomonas and acinetobacter were pneumonias, had a late onset and were secondary endogenous infections.

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Ramos, L.C., García, C., Iribarren, J. et al. Colonization and infection by potential Gram-negative multiresistant microorganism in a medical–surgical ICU. Crit Care 12, P36 (2008). https://doi.org/10.1186/cc6257

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Keywords

  • Pneumonia
  • Urinary Tract Infection
  • Wound Infection
  • Early Onset
  • Late Onset