Risk factors for nosocomial infections caused by gram-negative bacilli. The Hellenic Antibiotic Resistance Study Group

Abstract

Two hundred and ninety-nine Gram-negative hospital-acquired infections from 257 patients, consecutively identified during one month (November 1992) in five hospitals in the greater Athens area, were divided into four groups on the basis of the bacterium isolated: Group 1 (Escherichia coli group) included infections owing to E. coli, Group 2 (Proteus group) consisted of infections owing to Proteus spp. and Providencia spp., Group 3 (Kiebsiella/Enterobacter group) involved infections owing to Kiebsiella spp., Enterobacter spp., Citrobacter spp. and Serratia spp. Infections owing to Pseudomonas spp. and other non-fermenters were allocated into Group 4 (non-fermenters group). The four groups were studied in relation to risk factors including the duration of hospitalization, type of ward, underlying disease, history of operation, medical procedures/devices and antimicrobial therapy. A stepwise multiple logistic regression technique (SPSS Inc) was used to analyse the data, and the three groups (the Proteus group, the Klebsiella/Enterobacter group and the non-fermenters group) were analysed separately against the E. coli group. Infections with the Kiebsiella/Enterobacter group were associated with: (a) length of hospital stay before the infection, (b) treatment with newer antibiotics, and (c) hospitalization in an intensivecare unit (ICU). Infections with non-fermenters were associated with: (a) length of hospital stay before infection, (b) a urinary catheter, (c) type of disease (chronic infection being negatively associated), (d) treatment with newer antibiotics and (e) hospitalization in an ICU. Proteus group infections were associated with (a) length of hospital stay before infection, (b) treatment with newer antibiotics and (c) operation during present hospitalization (negative association). Interestingly, no specific hospitals were identified as risk factors. Identification of patients at risk for acquiring an infection owing to a nosocomial pathogen is vital in the development of a preventive strategy for hospital-acquired infections.