The Role of Systemic Antibiotics in Acquiring Respiratory Tract Colonization With Gram-Negative Bacteria in Intensive Care Patients: A Nested Cohort Study

Irene P. Jongerden*, Ben Speelberg, Claudia L. Satizabal, Anton G. Buiting, Maurine A. Leverstein-van Hall, Jozef Kesecioglu, Marc J. Bonten

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: Colonization of the respiratory tract with Gram-negative bacteria in intensive care patients increases the risk of subsequent infections. Application of systemic antibiotics may prevent colonization with Gram-negative bacteria, but this effect has never been quantified. The objective of this study was to determine associations between systemic antibiotic use and acquisition of respiratory tract colonization with Gram-negative bacteria in ICUs.

Design: A nested cohort study.

Setting: A university hospital and a teaching hospital.

Patients: Patients with ICU stay of more than 48 hours and absence of respiratory tract colonization with Gram-negative bacteria on ICU admission.

Interventions: None.

Measurements and Main Results: Acquisition was determined through protocolized surveillance. Associations were investigated with Cox regression models with antibiotics as a time-dependent covariate. In all, 250 of 481 patients (52%) acquired respiratory tract colonization with Gram-negative bacteria after a median of 5 days (interquartile range, 3-8 d) (acquisition rate, 77.1/1,000 patient-days at risk). Antibiotic exposure during ICU admission was present in 78% and 72% of the patients with and without acquired Gram-negative bacteria colonization, respectively. In Kaplan-Meier curve analysis, the median times to acquisition of Gram-negative bacteria were 9 days (95% CI, 7.9-10.1) and 6 days (95% CI, 4.8-7.2) in patients receiving and not receiving antibiotics, respectively. In time varying Cox regression analysis, however, the association between acquired colonization and systemic antibiotics was not statistically significant (hazard ratio, 0.90; 95% CI, 0.70-1.16).

Conclusions: Among patients not colonized with Gram-negative bacteria in the respiratory tract at admission to ICU, systemic antibiotics during ICU stay were not associated with a reduction in acquisition of Gram-negative bacteria carriage in the respiratory tract during the ICU stay.

Original languageEnglish
Pages (from-to)774-780
Number of pages7
JournalCritical Care Medicine
Volume43
Issue number4
DOIs
Publication statusPublished - Apr 2015

Keywords

  • antibiotic resistance
  • antibiotics
  • cross infection
  • Gram-negative bacteria
  • intensive care
  • respiratory tract infections
  • VENTILATOR-ASSOCIATED PNEUMONIA
  • RESISTANT ACINETOBACTER-BAUMANNII
  • RISK-FACTORS
  • PSEUDOMONAS-AERUGINOSA
  • STENOTROPHOMONAS-MALTOPHILIA
  • MECHANICAL VENTILATION
  • DIGESTIVE-TRACT
  • UNIT PATIENTS
  • ICU PATIENTS
  • ACQUISITION

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