DETERMINATION OF FACTORS ASSOCIATED WITH EXTENSIVELY DRUG-RESISTANT PSEUDOMONAS AERUGINOSA INFECTION AMONG INTENSIVE CARE UNIT PATIENTS AT ROI ET HOSPITAL, THAILAND

摘要

Drug-resistance is a major problem in Thailand. The aim of this study was to determine the factors associated with extensively drug resistant Pseudomonas aeruginosa (XDR-PA) infections among intensive care unit patients at Roi Et Hospital, Thailand in order to guide efforts to reduce the risk for these infections. We retrospectively reviewed the records of intensive care unit (ICU) patients at Roi Et Hospital from 1 January 2014 to 31 December 2015. We compared those with XDR-PA to those without XDR-PA. Inclusion criteria for study subjects were age >= 15 years, being treated in the ICU for >= 48 hours and having laboratory confirmed XDR-PA during the study period at the study hospital. Control patients had the same inclusion criteria as study subjects but did not have XDR-PA. The ratios of cases to controls was 1:2. We used multiple logistic regression analysis to evaluate factors potentially associated with having XDR-PA. A total of 47 cases and 94 controls were included in the study. The mean (range) age of cases were 67 (21-87) years and of controls was 57 (19-87) years. Fifty-five percent of cases and 60% of controls were males. Seventy-nine percent of cases and 61% of controls were married. Factors significantly associated with XDR-PA on multiple logistic regression analysis were age >60 years [Odds Ratio (OR) = 2.60; 95% Confidence Interval (CI): 1.25-5.40], hospitalization for >7 days (OR = 5.86; 95%CI: 2.40-14.34), having an indwelling urinary catheter (OR = 1.97; 95%CI: 1.37-5.41), having had a tracheostomy (OR = 1.83; 95%CI: 1.24-6.30), having an endotracheal tube (OR = 2.56; 95%CI: 1.20-5.45), having mechanical ventilation (OR = 2.81; 95%CI: 1.29-6.11) and having had surgery (OR = 3.72; 95%CI: 1.51-9.12). In our study age >60 years, hospitalization for >7 days, having a urinary catheter, a tracheostomy, an endotracheal tube, mechanical ventilation and surgery were all significantly associated with XDR-PA infection. Urinary catheters and endotracheal tubes should be removed as soon as possible. Patients aged >60 years, who have prolonged hospitalization, or have had surgery, a tracheostomy or mechanical ventilation should be monitored carefully for early signs of infection. Strict infection control measures must be implemented in these patients. Further studies are needed to determine if these measures can reduce the risk for contracting XDR-PA infection in the ICU of the study hospital.