Anest. intenziv. Med. 2003;14(6):278-283

Risk Factors Associated with Colonisation/Infection by Multiresistant Strains of Klebsiella pneumoniae in Patients at Department of Anaesthesiology and Intensive Care Medicine, University Hospital in Hradec KrálovéArticles

P. Matoulková¹, P. Čermák², P. Klemera³, V. Černý⁴, J. Vlček¹

¹ Katedra sociální a klinické farmacie, Farmaceutická fakulta, Univerzita Karlova, Hradec Králové, vedoucí katedry doc. RNDr. J. Vlček, CSc.

² Ústav klinické mikrobiologie, Fakultní nemocnice, Hradec Králové, přednosta prof. MUDr. J. Horáček

³ Katedra biofyzi

Objective:
The aim of the study was to determine risk factors for multiresistant Klebsiella pneumoniae isolation in thecritically ill patietns.

Design: Prospective, observational study.Setting: The studywascarried out at the Department of Anaesthesiology and Intensive Medicine, University Hospital, Hradec Králové, Czech RepublicMaterial and methods: All patients hospitalized with at least one positive isolation of Klebsiella pneumoniae were enrolledinto the study. The exposure to antibiotics during hospitalization or one month preceding hospitalization; age; gender;APACHE II and SOFA scores on admission; day of ICU stay when sample for microbiological investigation was taken (laterdemonstrated to be positive for Klebsiella pneumoniae); metabolic disorder (diabetes mellitus) and underlying diagnosiswere considered to be potential risk factors formultiresistant Klebsiella pneumoniae isolation. For the purpose of this studythe index of insusceptibility (IN) was designed to evaluate multiresistance. Risk factors were investigated by means ofunivariant and multinominal linear regression analyses. A P value below 0.05 was considered statistically significant.

Results: Exposure to aminoglycosides (P=0.033), carbapenems (P=0.043) as well as underlying diagnosis - respiratory tractdiseases (IDC-10 version) (P=0.002) were found to be independent predictors of multidrug-resistant Klebsiella pneumoniaestrain isolation.

Conclusion: Antibiotic selection pressure plays an important role in colonization/infection of critically ill patients bymultidrug-resistant bacterial strains.

Keywords: Klebsiella pneumoniae; multidrug resistance; selection pressure; antibiotics; intensive care

Published: December 1, 2003  Show citation