Multidrug-Resistant Bacteria on Critically Ill Patients with Sepsis at Hospital Admission: Risk Factors and Effects on Hospital Mortality

Abstract

Marcelo de Oliveira Maia,1,2 Carlos Darwin Gomes da Silveira,1,3,4 Maura Gomes,5 Sérgio Eduardo Soares Fernandes,3 Rosália Bezerra de Santana,3 Daniella Queiroz de Oliveira,3 Felipe Ferreira Pontes Amorim,4 Francisco de Assis Rocha Neves,2 Fábio Ferreira Amorim1,2 1Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil; 2Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil; 3Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil; 4Medical School, Centro Universitário do Planalto Central (UNICEPLAC), Brasília, Federal District, Brazil; 5Intensive Care Unit, Hospital Santa Luzia Rede D’Or São Luiz, Brasília, Federal District, BrazilCorrespondence: Fábio Ferreira Amorim, Coordenação de Pesquisa e Comunicação Científica - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, 70701-907, Brazil, Email [email protected] Marcelo de Oliveira Maia, Programa de Pós-Graduação em Ciências da Saúde - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, 70701-907, Brazil, Email [email protected]: To evaluate the effect of MDRO infection on hospital mortality and the risk factors among critically ill patients with sepsis at hospital admission.Patients and Methods: A cross-sectional study was performed between April 2019 and May 2020, followed by a cohort to evaluate hospital mortality that prospectively included all consecutive patients 18 years or older with sepsis admitted within 48 hours of hospital admission to an adult ICU in Brazil. Patients’ characteristics, blood samples within one hour of ICU admission, and microbiological results within 48h of hospital admission were collected. In addition, descriptive statistics, binary logistic regression, and propensity score matching were performed.Results: At least one MDRO was isolated in 85 patients (9.8%). The extended-spectrum beta-lactamase-producing Enterobacterales are the most frequent organism (56.1%). Hypoxemic acute respiratory failure (OR 1.87, 95% CI 1.02– 3.40, p = 0.04), Glasgow Coma Score below 15 (OR 2.57, 95% CI 1.38– 4.80, p < 0.01), neoplasm (OR 2.66, 95% CI 1.04– 6.82, p = 0.04) and hemoglobin below 10.0 g/dL (OR 1.82, 95% CI 1.05– 3.16, p = 0.03) were associated with increased MDRO. Admission from the Emergency Department (OR 0.25, 95% CI 0.14– 0.43, p < 0.01) was associated with decreased MDRO. In the multivariate analysis, MDRO at hospital admission increased hospital mortality (OR 2.80, 95% CI 1.05– 7.42, p = 0.04). After propensity score-matching adjusted to age, APACHE II, SOFA, and dementia, MDRO at hospital admission was associated with significantly high hospital mortality (OR 2.80, 95% CI 1.05– 7.42, p = 0.04). The E-value of adjusted OR for the effect of MDRO infection on hospital mortality was 3.41, with a 95% CI of 1.31, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect.Conclusion: MDRO infection increased hospital mortality, and MDRO risk factors should be accessed even in patients admitted to ICU within 48 hours of hospital admission.Keywords: drug resistance, multiple, bacterial, community-acquired infections, sepsis, risk factors, mortality

Keywords

• drug resistance
• multiple
• bacterial
• community-acquired infections
• sepsis
• risk factors
• mortality