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Pseudomonas aeruginosa Colonization in the Intensive Care Unit: Prevalence, Risk Factors, and Clinical Outcomes

Published online by Cambridge University Press:  01 February 2016

Anthony D. Harris
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Sarah S. Jackson
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Gwen Robinson
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Lisa Pineles
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Surbhi Leekha
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Kerri A. Thom
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Yuan Wang
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Michelle Doll
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Melinda M. Pettigrew
Affiliation:
Yale School of Public Health, New Haven, Connecticut
J. Kristie Johnson
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Corresponding
E-mail address:

Abstract

OBJECTIVE

To determine the prevalence of Pseudomonas aeruginosa colonization on intensive care unit (ICU) admission, risk factors for P. aeruginosa colonization, and the incidence of subsequent clinical culture with P. aeruginosa among those colonized and not colonized.

METHODS

We conducted a cohort study of patients admitted to a medical or surgical intensive care unit of a tertiary care hospital. Patients had admission perirectal surveillance cultures performed. Risk factors analyzed included comorbidities at admission, age, sex, antibiotics received during current hospitalization before ICU admission, and type of ICU.

RESULTS

Of 1,840 patients, 213 (11.6%) were colonized with P. aeruginosa on ICU admission. Significant risk factors in the multivariable analysis for colonization were age (odds ratio, 1.02 [95% CI, 1.01–1.03]), anemia (1.90 [1.05–3.42]), and neurologic disorder (1.80 [1.27–2.54]). Of the 213 patients colonized with P. aeruginosa on admission, 41 (19.2%) had a subsequent clinical culture positive for P. aeruginosa on ICU admission and 60 (28.2%) had a subsequent clinical culture positive for P. aeruginosa in the current hospitalization (ICU period and post-ICU period). Of these 60 patients, 49 (81.7%) had clinical infections. Of the 1,627 patients not colonized on admission, only 68 (4.2%) had a subsequent clinical culture positive for P. aeruginosa in the current hospitalization. Patients colonized with P. aeruginosa were more likely to have a subsequent positive clinical culture than patients not colonized (incidence rate ratio, 6.74 [95% CI, 4.91–9.25]).

CONCLUSIONS

Prediction rules or rapid diagnostic testing will help clinicians more appropriately choose empirical antibiotic therapy for subsequent infections.

Infect Control Hosp Epidemiol 2016;37:544–548

Type
Original Articles
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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