Research Article: Association between rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) and subsequent infection with HR-GNRs in clinical patients: A one year historical cohort study

Date Published: January 25, 2019

Publisher: Public Library of Science

Author(s): Dennis Souverein, Sjoerd M. Euser, Bjorn L. Herpers, Jan Kluytmans, John W. A. Rossen, Jeroen W. Den Boer, Michael Osthoff.

http://doi.org/10.1371/journal.pone.0211016

Abstract

Rectal colonization with Highly Resistant Gram-negative Rods (HR-GNRs) probably precedes infection. We aimed to assess the association between rectal HR-GNR colonization and subsequent HR-GNR infection in clinical patients during a follow-up period of one year in a historical cohort study design.

Rectal HR-GNR colonization was assessed by culturing. Subsequent development of infection was determined by assessing all clinical microbiological culture results extracted from the laboratory information system including clinical data regarding HR-GNR infections. A multivariable logistic regression model was constructed with HR-GNR rectal colonization as independent variable and HR-GNR infection as dependent variable. Gender, age, antibiotic use, historic clinical admission and previous (HR-GNR) infections were included as possible confounders.

1133 patients were included of whom 68 patients (6.1%) were colonized with a HR-GNR. In total 22 patients with HR-GNR infections were detected. Urinary tract infections were most common (n = 14, 63.6%), followed by bloodstream infections (n = 5, 22.7%) and other infections (n = 8, 36.4%). Eight out of 68 HR-GNR colonized patients (11.8%) developed a subsequent HR-GNR infection compared to 14 out of 1065 HR-GNR negative patients (1.3%), resulting in an odds ratio (95% CI) of 7.1 (2.8–18.1) in the multivariable logistic regression analyses.

Rectal colonization with a HR-GNR was a significant risk factor for a subsequent HR-GNR infection.

Partial Text

Infections are frequently seen by general practitioners (GPs) and medical specialists in the Netherlands [1]. In general, a rapid diagnosis and effective empirical antibiotic therapy are important to prevent complications. Examples are, pyelonephritis or bloodstream infection (BSI) in patients with a urinary tract infection (UTI) [2]. However, rising resistance rates hamper effective antibiotic treatment increasing the risk of treatment failure and complications [3]. Clinical infections with Highly Resistant Gram-negative Rods (HR-GNR) are associated with an increased risk of morbidity, mortality, and healthcare costs compared to susceptible micro-organisms [4–8].

In the present study, we aimed to assess the association between rectal HR-GNR colonization and subsequent HR-GNR infection over a follow-up period of one year in the clinical patient population. We analysed 1,133 patients of whom 68 patients (6.1%) were rectally colonized with a HR-GNR micro-organism. Eight out of 68 HR-GNR colonized patients (11.8%) developed a subsequent HR-GNR infection compared to 14 out of 1065 HR-GNR negative patients (1.3%), resulting in an odds ratio (95% CI) of 7.1 (2.8–18.1) in the multivariable logistic regression analyses.

 

Source:

http://doi.org/10.1371/journal.pone.0211016

 

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