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 nosocomia l pulmonary infection (NPI) in intensive care units (ICUs) associated with antimicrobial-resistant bacteria (NPI-ARB) and to compare survival after NP I-ARB with NPI due to antimicrobial-sensitive bacteria (NPI-ASB). We analys ed 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 patien ts). Variables associated with NPI-ARB were identified by multivariate logi stic regression. Survival was calculated using the Kaplan-Meier method. A m edical condition for ICU admission [odds ratio (OR) 1.98, 95% confidence in terval (95% CI) 1.35-2.91], transfer from another hospital ward [OR 1.66, 9 5% 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 mechan ical ventilation [OR 2.10, 95% CI (1.31-3.36)] were independent risk factor s of NPI-ARB. Median survival was 35 days after NPI-ARB and 32 days after N PI-ASB (P = 0.92). Survival after bacterial NPI was not associated with ant imicrobial susceptibility. (C) 2000 The Hospital infection Society.