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Acquisition of carbapenem-resistant gram-negative bacilli among intensive care unit (ICU) patients with no previous use of carbapenems: Indirect population impact of antimicrobial use

Published online by Cambridge University Press:  14 February 2022

Juliana da Silva Oliveira ,
Natalie Carlos Ferreira Melo Sampaio Open the ORCID record for Natalie Carlos Ferreira Melo Sampaio [Opens in a new window] ,
Gabriela Silveira Leite ,
Milena Aparecida Del Masso Pereira  and
Carlos Magno Castelo Branco Fortaleza Open the ORCID record for Carlos Magno Castelo Branco Fortaleza [Opens in a new window]
Juliana da Silva Oliveira
Affiliation:
Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
Natalie Carlos Ferreira Melo Sampaio
Affiliation:
Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
Gabriela Silveira Leite
Affiliation:
Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
Milena Aparecida Del Masso Pereira
Affiliation:
Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
Carlos Magno Castelo Branco Fortaleza*
Affiliation:
Department of Infectious Diseases, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
*
Author for correspondence: Carlos Magno Castelo Branco Fortaleza, E-mail: carlos.fortaleza@unesp.br
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Abstract

Objective:

To measure the impact of exposure to patients using carbapenem on the acquisition of carbapenem-resistant gram-negative bacilli (CR-GNB) among patients not using carbapenems.

Design:

An ecological study and a cohort study.

Setting:

Two medical surgical intensive care units (ICUs) in inner Brazil.

Participants:

Patients admitted to 2 ICUs from 2013 through 2018 to whom carbapenem was not prescribed.

Methods:

In the ecologic study, the monthly use of carbapenems (days of therapy [DOT] per 1,000 patient days) was tested for linear correlation with the 2-month moving average of incidence CR-GNB among patients to whom carbapenem was not prescribed. In the cohort study, those patients were addressed individually for risk factors (demographics, invasive interventions, use of antimicrobials) for acquisition of CR-GNB, including time at risk and the “carbapenem pressure,” described as the aggregate DOT among other ICU patients during time at risk. The analysis was performed in univariate and multivariable Poisson regression models.

Results:

The linear regression model revealed an association of total carbapenem use and incidence of CR-GNB (coefficient, 0.04; 95% confidence interval [CI], 0.02–0.06; P = .001). In the cohort model, the adjusted rate ratio (RR) for carbapenem DOT was 1.009 (95% CI, 1.001–1.018; P = .03). Other significant risk factors were mechanical ventilation and the previous use of ceftazidime (with or without avibactam).

Conclusions:

Every additional DOT of total carbapenem use increased the risk of CR-GNB acquisition by patients not using carbapenems by nearly 1%. We found evidence for a population (“herd effect”-like) impact of antimicrobial use in the ICUs.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 11 , November 2022 , pp. 1575 - 1579
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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