TABLE 2.
Characteristics associated with acquired carriage of high-level AmpC cephalosporinase-producing Enterobacteriaceae during the intensive care unit stay in patients not colonized at admission
| Variablea | Intestinal carriage of HLAC-PE during the ICU stay |
P value | |
|---|---|---|---|
| Acquisition (n = 107) | No acquisitionb (n = 551) | ||
| Type of ICU stay, no. (%) | 0.03 | ||
| Medical | 89 (83.2) | 498 (90.4) | |
| Surgical | 18 (16.8) | 53 (9.6) | |
| Median SAPS II at ICU admission (interquartile range) | 49 (40–58) | 42 (32–55) | 0.0002 |
| Main diagnoses of the ICU stay, no. (%) | |||
| Sepsis | 72 (67.3) | 333 (60.4) | 0.18 |
| Neurological | 15 (14.0) | 83 (15.1) | 0.78 |
| Renal | 37 (34.6) | 137 (24.9) | 0.04 |
| Cardiac | 23 (21.5) | 108 (19.6) | 0.65 |
| Intestinal/hepatic | 5 (4.7) | 29 (5.3) | 0.80 |
| Trauma | 19 (17.7) | 72 (13.1) | 0.20 |
| Antimicrobial exposure during the ICU stayc, no. (%) | |||
| Antimicrobial, any | 104 (97.2) | 401 (72.3) | <0.0001 |
| Penicillins | 16 (14.9) | 102 (18.5) | 0.38 |
| Median duration, days (interquartile range) | 3 (3–6) | 5 (3–8) | 0.83 |
| Penicillin + beta-lactamase inhibitor associations | 49 (45.8) | 251 (45.5) | 0.96 |
| Median duration, days (interquartile range) | 6 (4–9) | 6 (4–8) | 0.51 |
| Third- and fourth-generations cephalosporins | 71 (66.4) | 298 (54.1) | 0.02 |
| Median duration, days (interquartile range) | 5 (3–9) | 7 (4–9) | 0.19 |
| Carbapenems | 12 (11.2) | 48 (8.7) | 0.41 |
| Median duration, days (interquartile range) | 5 (3–7) | 6 (3–9) | 0.86 |
| Aminoglycosides | 21 (19.6) | 120 (21.8) | 0.62 |
| Median duration, days (interquartile range) | 3 (1–3) | 3 (2–4) | 0.97 |
| Fluoroquinolones | 0 | 26 (4.7) | 0.02 |
| Median duration, days (interquartile range) | 5 (2–9) | NA | |
| Metronidazole | 33 (30.8) | 113 (20.5) | 0.02 |
| Median duration, days (interquartile range) | 7 (5–10) | 6 (3–8) | 0.13 |
| Glycopeptides | 15 (14.0) | 76 (13.8) | 0.95 |
| Median duration, days (interquartile range) | 4 (2–6) | 4 (3–7) | 0.28 |
| ESBL-PE carriage, no. (%) | |||
| At ICU admission | 3 (2.8) | 16 (2.9) | 0.95 |
| Acquired in the ICU | 6 (5.6) | 15 (2.7) | 0.12 |
| Use of life-sustaining therapy during the ICU stay, no. (%) | |||
| Mechanical ventilation | 96 (89.7) | 409 (74.2) | <0.0001 |
| Vasopressors | 74 (69.1) | 308 (55.9) | 0.01 |
| Renal replacement therapy | 22 (20.6) | 62 (11.2) | 0.008 |
| Median length of ICU stay, days (interquartile range) | 18 (10–30) | 11 (7–17) | <0.0001 |
a
Age, gender, comorbidities, and history of previous hospitalization or surgery did not differ between patients with acquired carriage and noncarriers (data not shown).
b
Only patients with at least one surveillance swab collected during the ICU stay were included as comparators (527 patients not colonized at admission were discharged alive or died in the ICU before a first weekly surveillance swab was collected).
c
Between ICU admission and the first positive rectal swab in patients with acquired HLAC-PE carriage and during the whole ICU stay in noncarriers.