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The rising influx of multidrug-resistant Gram-negative bacilli into a tertiary care hospital [Article de Revue]

[L'augmentation croissante des bacilles gram-négatifs résistants aux antibiotiques dans les établissements de soins spécialisés]
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
Clinical infectious diseases. 2005/06/15; 40(12) : 1792-8
Summary: METHODS: Over a 6-year period, patients who harbored MDR-GNB (i.e., patients who had MDR-GNB isolates recovered from clinical cultures within the first 48 h after hospital admission) were identified. "MDR-GNB isolates" were defined as Pseudomonas aeruginosa, Escherichia coli, Enterobacter cloacae, and Klebsiella species isolates with resistance to at least 3 antimicrobial groups. A case-control study was performed to determine the independent risk factors for harboring MDR-GNB at hospital admission. RESULTS: Between 1998 and 2003, the prevalence of MDR-GNB isolates recovered from patients at hospital admission increased significantly for all isolate species (P<.001), with the exception of P. aeruginosa (P=.09). Of 464 MDR-GNB isolates, 12%, 35%, and 53% of isolates were coresistant to 5, 4, and 3 antimicrobial groups, respectively. Multivariable analysis identified age > or = 65 years (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.1-7.4; P<.04), prior exposure to antibiotics for > or = 14 days (OR, 8.7; 95% CI, 2.5 -30; P<.001), and prior residence in a long-term care facility (OR, 3.5; 95% CI, 1.3-9.4; P < .01) as independent risk factors for harboring MDR-GNB at hospital admission. CONCLUSION: A substantial number of patients harbor MDR-GNB at hospital admission. Identification of common coresistance patterns among MDR-GNB isolates may assist in the selection of empirical antimicrobial therapy for patients with a high risk of harboring MDR-GNB.(RESUME D'AUTEUR)
, 2005/06/15



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CClin Est
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CClin Paris-Nord
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33076 Bordeaux
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