Nosocomial pulmonary infection by antimicrobial-resistant bacteria of patients hospitalized in intensive care units: risk factors and survival

The objectives of this study were to identify the risk factors of nosocomial pulmonary infection (NPI) in intensive care units (ICUs) associated with antimicrobial-resistant bacteria (NPI-ARB) and to compare survival after NPI-ARB with NPI due to antimicrobial-sensitive bacteria (NPI-ASB). We analysed data from a surveillance network monitoring nosocomial infections in 27 mixed ICUs in the south-east of France. NPI surveillance data were recorded for 628 patients with documented NPI. The patients were stratified into 2 groups by type of pneumonia: NPI-ASB (445 patients) vs. NPI-ARB (183 patients). Variables associated with NPI-ARB were identified by multivariate logistic regression. Survival was calculated using the Kaplan-Meier method. A medical condition for ICU admission [odds ratio (OR) 1.98, 95% confidence interval (95% CI) 1.35-2.91], transfer from another hospital ward [OR 1.66, 95% CI (1.14-2.42)], a colonized central venous catheter [OR 3.47, 95% CI (1.46-8.21)], a stay of > eight days [OR 1.02, 95% CI (1.03-1.05)] and mechanical ventilation [OR 2.10, 95% CI (1.31-3.36)] were independent risk factors of NPI-ARB. Median survival was 35 days after NPI-ARB and 32 days after NPI-ASB (P = 0.92). Survival after bacterial NPI was not associated with antimicrobial susceptibility. (C) 2000 The Hospital infection Society.