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. 2022 Jun 3;7(2):108-116.
doi: 10.3138/jammi-2021-0025. eCollection 2022 Jun.

Pattern of acquisition of hospital-associated pathogens in the ICU of an academic tertiary care hospital

Shazia Damji  1 , Jerrold Perrott  1 , Salomeh Shajari  1 , Jennifer Grant  1 , Titus Wong  1 , Megan Harbin  2
Affiliations

Pattern of acquisition of hospital-associated pathogens in the ICU of an academic tertiary care hospital

Shazia Damji et al. J Assoc Med Microbiol Infect Dis Can. .

Abstract
in English, French

Background: Among hospitalized patients, a 48-hour window from time of hospitalization defines nosocomial infections and guides empiric antibiotic selection. This time frame may lead to overuse of broad-spectrum antibiotics. Our primary objective was to determine the earliest and median time since hospital admission to acquire antibiotic-resistant pathogens among patients admitted to the intensive care unit (ICU) of an academic, tertiary care hospital.

Methods: Retrospective chart review was conducted for adult patients admitted to the ICU from home or another hospital within the same health authority in 2018, to identify the time to acquisition of hospital-associated pathogens: methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales, non-ESBL ceftriaxone-resistant Enterobacterales, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Patients transferred from hospitals outside the health authority, admitted to ICU after 14 days of hospitalization, who were solid organ or bone marrow transplant recipients, or who were otherwise immunocompromised were excluded.

Results: In 2018, 1,343 patients were admitted to this ICU; 820 met the inclusion criteria. Of these, 121 (14.76%) acquired a hospital-associated pathogen in the ICU. The probability of isolating a hospital-associated pathogen by 48 hours of hospital admission was 3%. The earliest time to isolate any of these pathogens was 29 hours, and the median was 9 days (interquartile range [IQR] 3.8-15.6 days).

Conclusions: Most patients (85.3%) in this ICU never acquired a hospital-associated pathogen. The median time to acquire a hospital-associated pathogen among the remaining patients suggests that initiating empiric broad-spectrum antibiotics on the basis of a 48-hour threshold may be premature.

Historique : Chez les patients hospitalisés, une fenêtre de 48 heures après le moment de l’hospitalisation définit les infections nosocomiales et oriente la sélection d’antibiotiques empiriques. Cette période peut favoriser la surutilisation d’antibiotiques à large spectre. L’objectif primaire de l’étude visait à déterminer la période la plus courte et la période médiane à compter de l’admission pour que les patients admis en soins intensifs à partir d’un hôpital universitaire de soins tertiaires contractent des agents pathogènes antibiorésistants.

Méthodologie: Les chercheurs ont procédé à un examen rétrospectif des dossiers des patients adultes admis en soins intensifs à partir de la maison ou d’un autre hôpital de la même autorité sanitaire en 2018, afin de déterminer la période avant de contracter des agents pathogènes associés au milieu hospitalier : Staphylococcus aureus résistant à la méthicilline, entérocoque résistant à la vancomycine, Enterobacterales producteurs de bêta-lactamases à spectre élargi (BLSE), Enterobacterales résistant à la ceftriaxine non producteurs de BLSE, Pseudomonas aeruginosa et Stenotrophomonas maltophilia. Ont été exclus les patients transférés d’un hôpital hors de l’autorité sanitaire, admis en soins intensifs plus de 14 jours après l’hospitalisation, receveurs d’un organe plein ou de moelle osseuse ou autrement immunodéprimés.

Résultats: En 2018, 1 343 patients ont été admis en soins intensifs, dont 820 respectaient les critères d’inclusion. De ce nombre, 121 (14,67 %) ont contracté un agent pathogène en soins intensifs. La probabilité d’isoler un tel agent dans les 48 heures suivant l’admission en milieu hospitalier s’élevait à 3 %. Ces agents pathogènes ont été isolés au plus tôt 29 heures après l’hospitalisation, et au bout d’une période médiane de neuf jours (plage interquartile [PIQ] 3,8 à 15,6 jours).

Conclusions: La plupart des patients (85,3%) de cette unité de soins intensifs n’ont jamais contracté d’agent pathogène associé au milieu hospitalier. Selon la période médiane avant d’acquérir un tel agent pathogène chez les autres patients, il serait prématuré d’entreprendre une antibiothérapie à large spectre au seuil de 48 heures.

Keywords: antibiotics; antibiotiques; antimicrobial stewardship; critical care; gestion des antimicrobiens; health care–associated infections; infections associées aux soins de santé; infections nosocomiales; nosocomial infections; soins intensifs.

PubMed Disclaimer

Conflict of interest statement

M Harbin has received payment from the University of British Columbia, Faculty of Pharmaceutical Sciences, for a lecture for 2nd-year pharmacy students titled ‘Hospital-Acquired Pneumonia.’ The other authors have nothing to disclose.

Figures

Figure 1:
Figure 1:
Patient population ICU = Intensive care unit; HAP* = Hospital-associated pathogen (methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase–producing Enterobacterales, ceftriaxone-resistant Enterobacterales, Pseudomonas aeruginosa, and Stenotrophomonas maltophilia)
Figure 2:
Figure 2:
Kaplan–Meier analysis: (a) probability of hospital-associated pathogen-free ICU stay (N = 820 patients); (b)–(g) probability of a pathogen-free ICU stay for each individual hospital-associated pathogen ICU = Intensive care unit; CTX-R = ceftriaxon-resistant; MRSA = Methicillin-resistant Staphylococcus aureus; VRE = Vancomycin-resistant enterococci; ESBL = Extended-spectrum beta-lactamase
See this image and copyright information in PMC

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