Risk factors for gastrointestinal colonization and acquisition of carbapenem-resistant Gram-negative bacteria among patients in intensive care units in Thailand [PublishAheadOfPrint]

This study was conducted to investigate the prevalence and risk factors for carbapenem-resistant Gram-negative Bacteria (CR-GNB) colonization and acquisition among patients admitted to Intensive Care Units (ICUs) in two tertiary care hospitals in Northern Thailand. Rectal swab screening for CR-GNB was performed on patients at ICU admission and discharge. Phenotypes and genotypes of all isolates were determined. Risk factors were analyzed by logistic regression analysis. Overall, carriage rates of CR-GNB at admission was 11.6% (32/275), mostly with Acinetobacter baumannii (n = 15) followed by Klebsiella pneumoniae (n = 9). The risk factor for CR-GNB colonization was hospitalization within the previous 6 months (P = 0.002). During ICU stay, the rate of CR-GNB acquisition was 25.2% (52/206), predominantly A. baumannii (n = 28) and K. pneumoniae (n = 13). Risk factors associated with CR-GNB acquisition were the use of enteral feeding tube (P = 0.008) and administration of third generation cephalosporins (P = 0.032) and carbapenems (P = 0.045). The most common carbapenemase genes in A. baumannii and K. pneumoniae were bla_OXA-23/51 and bla_NDM, respectively. Patient-to-patient transmission was demonstrated in three cases resulting in the acquisition of CR-A. baumannii spp. (2 cases) and K. pneumoniae (1 case) isolates from other patients who were admitted during the same period of time. This is the first Indochinese study screening patients and examining carriage of CR-GNB, and further demonstrating transfer of CR-GNB isolates in ICUs. Our study suggested that effective infection control measures are required to limit the spread of CR-GNB within the hospitals.

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