Table 1.
Clinical characteristic investigated for association with CR-GNB sepsis (Case group 1) in an adult clinical-surgical ICU
| Predictive Factors | Univariate analysis | Odds ratio | 95% CI | Pt valor | |
|---|---|---|---|---|---|
| CR-GNB (n = 60) | Controls (n = 94) | ||||
| Demographic data | |||||
| Age in years, median (range) | 62 (23–91) | 62 (19–92) | 1.00 | 0.98–1.02 | 0.95 |
| Male sex, n (%) | 36 (60) | 46 (49) | 1.57 | 0.81–3.02 | 0.18 |
| Comorbiditiesa, n (%) | |||||
| Diabetes mellitusb | 21 (35) | 35 (37) | 0.91 | 0.46–1.78 | 0.78 |
| Renal failurec | 30 (50) | 38 (40) | 1.47 | 0.77–2.83 | 0.25 |
| Hemodialysisd | 22 (37) | 18 (19) | 2.44 | 1.17–5.10 | 0.02 |
| Chronic liver diseasee | 2 (3) | 9 (10) | 0.33 | 0.07–1.56 | 0.16 |
| Immunossupressive conditionf | 9 (15) | 11 (12) | 1.33 | 0.52–3.43 | 0.55 |
| Gastrointestinal disease | 16 (27) | 18 (19) | 1.54 | 0.71–3.31 | 0.27 |
| Geniturinary disease | 5 (8) | 9 (10) | 0.86 | 0.27–2.70 | 0.79 |
| Pulmonary disease | 10 (17) | 14 (15) | 1.14 | 0.47–2.77 | 0.77 |
| AIDS or chronic infectious disease | 3 (5) | 3 (3) | 1.60 | 0.31–8.18 | 0.56 |
| Surgeryg | 26 (43) | 46 (49) | 0.80 | 0.42–1.53 | 0.50 |
| Infection/Colonization by CR-GNB | 19 (32) | 7 (7) | 5.76 | 2.24–14.79 | < 0.001 |
| Nosocomial diarrheah | 17 (28) | 6 (6) | 5,.80 | 2.13–15.75 | 0.001 |
| Neutropeniai | 5 (8) | 4 (4) | 2.05 | 0.53–7.94 | 0.30 |
| Neoplasm | 23 (38) | 28 (30) | 1.47 | 0.74–2.90 | 0.27 |
| Infection | 46 (77) | 31 (33) | 6.68 | 3.20–13.95 | < 0.001 |
| Prior ICU hospitalization, n (%) | 7 (12) | 5 (5) | 2.35 | 0.71–7.78 | 0.26 |
| Length of hospital stay (in days) | |||||
| Median (range) | 26.5 (1–375) | 10 (0–143) | 1.04 | 1.02–1.06 | < 0.001 |
| ICU hospitalization reason, n (%) | |||||
| Elective or emergency surgery | 10 (17) | 28 (30) | 0.47 | 0.21–1.06 | 0.07 |
| Respiratory tract disease | 16 (27) | 14 (15) | 2.08 | 0.93–4.65 | 0.08 |
| Cardiovascular disease | 6 (10) | 8 (9) | 1.19 | 0.39–3.63 | 0.75 |
| Neurological disease | 2 (3) | 11 (12) | 0.26 | 0.06–1.22 | 0.09 |
| Gastrointestinal disease | 3 (5) | 5 (5) | 0.94 | 0.22–4.07 | 0.93 |
| Renal pathology | 5 (8) | 11 (12) | 0.69 | 0.23–2.08 | 0.51 |
| Sepsis | 31 (52) | 30 (32) | 2.40 | 1.23–4.68 | 0.01 |
| Sepsis shock | 23 (38) | 27 (39) | 1.63 | 0.82–3.24 | 0.17 |
| Total SOFA scorej at ICU admission, | |||||
| Median (range) | 6 (1–17) | 6 (0–17) | 1.06 | 0.98–1.15 | 0.16 |
| SAPs 3 scorek, median (range) | 65 (30–103) | 64 (29–105) | 1.01 | 0.99–1.03 | 0.39 |
| Invasive devices, n (%) | |||||
| Mechanical ventilation | 56 (93) | 58 (62) | 8.69 | 2.90–26.01 | < 0.001 |
| Central vascular catheter | 60 (100) | 81 (86) | ... | ... | 0.003 |
| Urinary catheter | 55 (92) | 72 (76) | 3.16 | 1.12–8.92 | 0.03 |
| Previous use of antimicrobials, n (%) | |||||
| Aminoglycosidesl | 18 (30) | 7 (7) | 5.33 | 2.07–13.74 | 0.001 |
| Cephalosporins, 3rd and 4rd generationsm | 8 (13) | 16 (17) | 0.75 | 0.30–1.88 | 0.54 |
| Carbapenemsn | 48 (80) | 32 (34) | 7.75 | 3.61–16.62 | < 0.001 |
| Glycopeptideso, linezolid and tigecycline | 45 (75) | 35 (37) | 5.06 | 2.47–10.37 | < 0.001 |
| Fluoroquinolonesp | 14 (23) | 15 (16) | 1.60 | 0.71–3.62 | 0.26 |
| Metronidazole | 11 (18) | 13 (14) | 1.40 | 0.58–3.37 | 0.46 |
| Piperacilin-tazobactam | 30 (50) | 21 (22) | 3.48 | 1.72–7.01 | < 0.001 |
| Polymyxinsq | 22 (37) | 9 (10) | 5.47 | 2.30–12.98 | < 0.001 |
| ATB with action for anaerobesr | 56 (93) | 59 (63) | 8.31 | 2.77–24.88 | < 0.001 |
| Antifungal agentss | 26 (43) | 13 (14) | 4.77 | 2.19–10.36 | < 0.001 |
Abbreviations: AIDS Acquired Immunodeficiency Syndrome, ATB antibiotic agents, CI Confidence interval, CR-GNB Carbapenem resistant Gram-negative bacilli, ICU Intensive Care Unit
aPrior comorbidities or conditions to investigated sepsis episode
bDiagnosis of diabetes mellitus requiring oral or injectable hypoglycemic drug
cCreatinine clearance < 30 cc/min
dRequired in the last 90 days
eLaboratory clinical evidence
f Prednisone > 10 mg for more than 50 days, corticosteroid for > 7 days or immunomodulatory agents (examples: monoclonal agents, methotrexate)
gIn the last 30 days
hNosocomial diarrhea (3 or more daily episodes of stool for 2 or more days)
iGranulocytes < 500 cells/mm3
jSequential Organ Failure Assessment score
kSimplified Acute Physiology Score III
lAmikacin and gentamicin
mCeftriaxone, ceftazidime and cefepime
nErtapenem, imipenem-cilastatin and meropenem
oDaptomycin, teicoplanin and vancomycin
pCiprofloxacin, levofloxacin, moxifloxacin
qPolymyxin B and colistin
rAntibacterial agents with action for anaerobes – Amoxicilin-clavulanate, ampicillin-sulbactam, piperacilin-tazobactam, clindamycin, ertapenem, imipenem, meropenem and metronidazole
sAmphotericin B family (standard, lipid complex or liposomal Amphotericin), echinocandins and azoles
tPearson’s chi-square test or Fisher’s exact test or Mann-Whitney-Wilcoxon U test, as required, and considering statistically significant p < 0.05