Clinical Impact of Multidrug-Resistant Organisms (MDRO) causing Healthcare-Associated Infections (HAIs) in 10 Colombian cities
HAIs by Multidrug-resistant Organisms (MDRO) place patients at greater risk of potentially untreatable infections with increased mortality and longer hospital stay. In Colombia, an increased trend of MDRO organisms have been reported in the last five years; however, their association with HAIs remains unascertained. Herein, we describe the clinical impact of MDRO causing HAI using a novel electronic-based tool for surveillance of HAIs.
A prospective cohort study between July 2012 and June 2013 was conducted in ICU patients from 20 hospitals in the 10 major Colombian cities. A novel electronic tool (HAI Solutions software ®) was implemented to gather, in real time, the clinical and microbiological data of HAI using CDC definitions. Prevalence by type of HAI, time to development of infection and mortality caused by the three most common bacteria was analyzed among groups during that year.
From 12607 isolates, 1041 (8.3%) met CDC criteria for HAIs; Klebsiella pneumoniae (Kpn) was the main isolated bacteria overall (19%), followed by Pseudomonas aeruginosa (Pae) with 12% and Escherichia coli (Eco) with 11%. Central line-associated bloodstream infection was the most common HAI with Kpn causing 63% of the cases (p<0.001), of which 19% were carbapenem-resistant Kpn. Eco was the first bacteria causing catheter-associated urinary tract infection (41%), of which 14% were carbapenem-resistant. MDR-Pae was the main cause of Ventilator-associated pneumonia after a median of 19 days, in comparison to non MDR-Pae (p<0.001). There was no significant difference in other HAIs for the other MDRO. Of note, 40% of MDR-Pae were re-isolated in a second culture after 15 days of the initial case. Mortality rates were higher for any carbapenem-resistant bacteria versus susceptible isolates: 30% vs 15% for Pae, 28% vs 17 for Kpn and 27% vs 10% for Eco.
This nationwide study reports for the first time, higher mortality rates in HAIs caused by MDRO. These findings highlight the need of implementing strategies to decrease MDRO associated with HAIs in Colombia.
V. M. Blanco, None
J. S. Muñoz, None
A. Correa, MSD: Speaker's Bureau, Speaker honorarium
E. De La Cadena, None
M. V. Villegas, MSD: Consultant and Speaker's Bureau, Consulting fee, Research support and Speaker honorarium
Astrazeneca: Consultant, Research support
Pfizer: Grant Investigator, Research grant
Merck SA Colombia: Speaker's Bureau, Research support and Speaker honorarium
Novartis: Consultant, Research support
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