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Volume 26, Number 6—June 2020
Research

Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units after Hospitalization in Emergency Department

Matias Chiarastelli SalomãoComments to Author , Maristela Pinheiro Freire, Icaro Boszczowski, Sueli F. Raymundo, Ana Rubia Guedes, and Anna S. Levin
Author affiliations: Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

Main Article

Table 1

Characteristics of patients, bivariate analysis, and conditional logistic regression of variables potentially associated with colonization by carbapenem-resistant Enterobacteriaceae at ICU admission, Hospital das Clínicas, São Paulo, Brazil, September 2015–July 2017*

Covariate Bivariate analysis
 Conditional logistic regression
Cases Controls OR (95% CI) p value OR (95% CI) p value
Female sex 34/103 (33) 91/201 (45) 0.58 (0.35–0.95) 0.03
Mean age, y (range)
 50.55 (14–84)
 49.78 (4–89)
 1.00 (0.99–1.01)
 0.62
Previous hospitalization at ICU admission
Previous stay in another unit during hospitalization 75/101 (74) 163/201 (81) 0.84 (0.44–1.60) 0.60
Previous stay in the ED during hospitalization 62/103 (60) 125/201 (62) 1.07 (0.65–0.77) 0.78
Length of ED stay, d 2 (0–55) 1 (0–37) 1.08 (1.01–1.15) 0.02 1.10 (1.02–1.19) 0.01
ED stay >2 d 34/103 (33) 35/201 (17) 2.45 (1.40–4.32) 0.002
Days of hospitalization before surveillance culture, median (range) 3 (1–95) 2 (1–37) 0.99 (0.99–0.99) <0.001
Transfer from another hospital 43/101 (43) 51/193 (26) 2.79 (1.26–3.68) 0.005 2.52 (1.07–5.89) 0.03
Previous hospitalization
 52/85 (61)
 63/163 (38)
 2.91 (1.53–5.52)
 0.001
Clinical characteristics at ICU admission
Infection 63/101 (63) 82/140 (42) 2.62 (1.52–4.54) 0.001 1.76 (0.56–5.50) 0.33
Sepsis 46/62 (74) 54/81 (66) 1.41 (0.52–3.85) 0.50
Surgery before ICU admission 53/102 (52) 106/194 (55) 0.92 (0.53–1.62) 0.78
Trauma 8/100 (8) 25/194 (13) 0.62 (0.28–1.40) 0.25
Stroke
 5/100 (5)
 17/194 (9)
 0.61 (0.17–2.18)
 0.45
Severity scores
SAPS 3, % median (range) 22 (4–92) 16 (0–98) 1.01 (1.002–1.02) 0.01 1.01 (1.002–1.03) 0.02
SOFA, median (range)
 5 (0–19)
 5 (0–19)
 1.09 (0.95–1.07)
 0.77
Invasive procedures and devices
Dialysis 14/100 (14) 11/194 (6) 2.50 (0.97–6.42) 0.06
Tracheostomy 2/99 (2) 1/194 (0) 4.92 (0.36–44.67) 0.26
Colostomy 2/99 (2) 2/194 (1) 2.00 (0.28–14.34) 0.49
Upper digestive endoscopy 10/101 (10) 5/194 (3) 3.70 (1.11–12.32) 0.003 18.9 (1.83–195.98) 0.01
Colonoscopy 2/101 (2) 0/194 (0)
Parenteral nutrition
 2/101 (2)
 1/ 194 (1)
 3.77 (0.19–74.94)
 0.38
Underlying conditions
CCI score, mean (range) 3.10 (0–9) 2.98 (0–11) 0.99 (0.96–1.02) 0.48
Smoking 25/62 (40) 46/137 (34) 1.17 (0.49–2.78) 0.72
Diabetes mellitus 20/102 (20) 44/198 (22) 0.86 (0.46–1.62) 0.65
Malignant neoplasm 9/102 (9) 23/198 (12) 0.77 (0.35–1.70) 0.52
Rheumatologic or autoimmune disease 11/102 (11) 16/198 (8) 1.44 (0.66–3.15) 0.36
Cirrhosis 15/102 (15) 11/198 (5) 2.25 (0.85–5.91) 0.10
Chronic kidney disease 12/102 (12) 14/198 (7) 1.51 (0.56–3.99) 0.40
Solid organ transplant 8/102 (8) 16/198 (8) 0.62 (0.23–1.64) 0.33
HIV infection 3/100 (3) 7/198 (4) 1.13 (0.27–4.76) 0.86
Hematological malignancy 2/102 (2) 6/198 (3) 0.59 (0.13–2.87) 0.52
Hematopoietic stem cell transplant
 1/102 (1)
 1/198 (0)
 2.00 (0.12–32.42)
 0.63
Antimicrobial drug use
Any drug at ICU admission† 81/99 (81) 142/193 (71) 1.56 (0.83–2.91) 0.161
Carbapenem at ICU admission† 25/80 (31) 12/141 (9) 3.92 (1.51–10.21) 0.005 4.62 (1.30–16.40) 0.02
Any drug use in previous 3 mo 50/72 (69) 48/145 (33) 5.38 (2.31–12.53) <0.001

*Values are no. (%) except as indicated. CCI, Charlson Comorbidity Index; ED, emergency department; GCS, Glasgow Coma Scale; ICU, intensive care unit; OR, odds ratio; SAPS 3, Simplified Acute Physiology 3, presented as prediction of mortality risk in percentage; SOFA, Sequential Organ Failure Assessment.
†Initiated >48 h before ICU admission.

Main Article

Page created: May 18, 2020
Page updated: May 18, 2020
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