Risk factors for tracheobronchial acquisition of resistant Gram-negative bacterial pathogens in mechanically ventilated ICU patients

Abstract

The aim of this study was to identify risk factors for tracheobronchial acquisition with the most common resistant Gram-negative bacteria in the intensive care unit (ICU) during the first week after intubation and mechanical ventilation. Tracheobronchial and oropharyngeal cultures were obtained at admission, after 48 hours, and after 7 days of mechanical ventilation. Patient characteristics, interventions, and antibiotic usage were recorded. Among 71 eligible patients with two negative bronchial cultures for resistant Gram-negative bacteria (at admission and within 48 hours), 41 (58%) acquired bronchial resistant Gram-negative bacteria by day 7. Acquisition strongly correlated with presence of the same pathogens in the oropharynx: Acinetobacter baumannii [odds ratio (OR) = 20·2, 95% confidence interval (CI): 5·5–73·6], Klebsiella pneumoniae (OR = 8·0, 95% CI: 1·9–33·6), and Pseudomonas aeruginosa (OR = 27, 95%: CI 2·7–273). Bronchial acquisition with resistant K. pneumoniae also was associated with chronic liver disease (OR = 3·9, 95% CI: 1·0–15·3), treatment with aminoglycosides (OR = 4·9, 95% CI: 1·4–18·2), tigecycline (OR = 4·9, 95% CI: 1·4–18·2), and linezolid (OR = 3·9, 95% CI: 1·1–15·0). In multivariate analysis, treatment with tigecycline and chronic liver disease were independently associated with bronchial resistant K. pneumoniae acquisition. Our results show a high incidence of tracheobronchial acquisition with resistant Gram-negative microorganisms in the bronchial tree of newly intubated patients. Oropharynx colonization with the same pathogens and specific antibiotics use were independent risk factors.

Keywords:

• Gram-negative bacteria
• Multidrug resistance
• Klebsiella pneumoniae
• Intensive care unit
• Respiratory
• Antimicrobial agents