Criterios de aislamiento preventivo para la detección de portadores de bacterias multirresistentes en pacientes ingresados en la UCI: estudio multicéntrico dentro del programa Resistencia Zero / Preventive isolation criteria for multidrug-resistant bacteria detection in patients admitted to the ICU: Multicenter study within the Zero Resistance program

Objetivo: Conocer el rendimiento de los criterios de aislamiento preventivo del programa Resistencia Zero (RZ) e identificar los factores que pudieran mejorar su rendimiento. Diseño: Estudio de cohorte prospectivo y multicéntrico. Ámbito: Unidades de cuidados críticos que aplicaban el protocolo RZ, y que aceptaron la invitación al estudio. Pacientes o participantes: Pacientes a los que se les realizaron cultivos de vigilancia (nasal, faríngeo, axilar y rectal) y/o diagnósticos al ingreso en la UCI. Intervenciones: Análisis de los factores de riesgo (FR) RZ y otras variables del registro ENVIN. Se realizó un estudio univariable y multivariable con metodología de regresión logística binaria (significación con p<0,05). Se efectuó análisis de sensibilidad y especificidad para cada uno de los factores seleccionados. Variables de interés principales: Portador de bacteria multirresistente (BMR) al ingreso en la UCI, FR (antecedente de colonización/infección por BMR, ingreso hospitalario en los 3 meses previos, uso de antibiótico el mes previo, estar institucionalizado, diálisis y otras condiciones crónicas) y comorbilidades. Resultados: Participaron 2.252 pacientes de 9 UCI españolas. Fueron identificados BMR en 283 (12,6%). Ciento noventa y tres (68,2%) presentaban algún FR (OR: 4,6; IC 95%: 3,5-6,0). Todos los FR del programa RZ alcanzaron significación estadística (sensibilidad: 66%; especificidad: 79%), siendo el antecedente de BMR el factor con más peso. Inmunodepresión, tratamiento antibiótico al ingreso y sexo masculino son FR adicionales para BMR. Se aislaron BMR en 87 (31,8%) sin FR. (AU)

Objective: To verify the validity of a check list of risk factors (RF) proposed by the Spanish “Resistencia Zero” project (RZ) in the detection of multi-resistant bacteria (MRB), as well as to identify other possible RF for colonization and infection by MRB at intensive care (ICU) admission. Design: A prospective cohort study, conducted in 2016. Setting: Multicenter study, patients who needed admission to adult critical care units that applied the RZ protocol and accepted the invitation for the study. Patients or participants: Consecutive sample of patients admitted to ICU, who underwent surveillance (nasal, pharyngeal, axillary, and rectal) or clinical cultures. Interventions: Analysis of the RF of RZ project, in addition to other comorbidities, included in the ENVIN registry. A univariate and multivariate study was conducted, with binary logistic regression methodology (significance with P<.05). Sensitivity and specificity analyses were performed for each of the selected factors. Main variables of interest: Carrier of BMR at ICU admission, RF (previous MRB colonization/infection, hospital admission in the previous 3 months, antibiotic use in the past month, institutionalization, dialysis, and other chronic conditions) and comorbidities. Results: Two thousand two hundred and seventy patients were included from 9 Spanish ICUs. We identified BMR in 288 (12.6% of total patients admitted). One hundred and ninety-three (68.2%) had some RF (OD 4.6 -95% CI 3.5-6.0). All 6 RF from check list achieved statistical significance in the univariate analysis (sensitivity 66%, specificity 79%). Immunosuppression, antibiotic use at ICU admission and male gender were additional RF for BMR. BMR were isolated in 87 patients (31.8%) without RF. (AU)

Preventive isolation criteria for the detection of multidrug-resistant bacteria in patients admitted to the Intensive Care Unit: A multicenter study within the Zero Resistance program.

OBJECTIVE: To verify the validity of a checklist of risk factors (RFs) proposed by the Spanish "Zero Resistance" project (ZR) in the detection of multidrug-resistant bacteria (MRB), and to identify other possible RFs for colonization and infection by MRB on admission to the Intensive Care Unit (ICU). DESIGN: A prospective cohort study, conducted in 2016. SETTING: Multicenter study, patients requiring admission to adult ICUs that applied the ZR protocol and accepted the invitation for participating in the study. PATIENTS OR PARTICIPANTS: Consecutive sample of patients admitted to the ICU and who underwent surveillance (nasal, pharyngeal, axillary and rectal) or clinical cultures. INTERVENTIONS: Analysis of the RFs of the ZR project, in addition to other comorbidities, included in the ENVIN registry. A univariate and multivariate analysis was performed, with binary logistic regression methodology (significance considered for p < 0.05). Sensitivity and specificity analyses were performed for each of the selected factors. MAIN VARIABLES OF INTEREST: Carrier of MRB on admission to the ICU, RFs (previous MRB colonization/infection, hospital admission in the previous 3 months, antibiotic use in the past month, institutionalization, dialysis, and other chronic conditions) and comorbidities. RESULTS: A total of 2270 patients from 9 Spanish ICUs were included. We identified MRB in 288 (12.6% of the total patients admitted). In turn, 193 (68.2%) had some RF (OR 4.6, 95%CI: 3.5-6.0). All 6 RFs from the checklist reached statistical significance in the univariate analysis (sensitivity 66%, specificity 79%). Immunosuppression, antibiotic use on admission to the ICU and the male gender were additional RFs for MRB. MRB were isolated in 87 patients without RF (31.8%). CONCLUSIONS: Patients with at least one RF had an increased risk of being carriers of MRB. However, almost 32% of the MRB were isolated in patients without RFs. Other comorbidities such as immunosuppression, antibiotic use on admission to the ICU and the male gender could be considered as additional RFs.