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Surg Infect (Larchmt). 2017 Jul;18(5):625-633. doi: 10.1089/sur.2016.255. Epub 2017 May 5.

Specific Clinical Profile and Risk Factors for Mortality in General Surgery Patients with Infections by Multi-Drug-Resistant Gram-Negative Bacteria.

Author information

1
1 General Surgery Department, Colorectal Surgery Unit, La Paz University Hospital , Madrid, Spain .
2
2 General Surgery Department, Upper GI Unit, La Princesa University Hospital , Madrid, Spain .
3
3 Microbiology Department, La Princesa University Hospital , Madrid, Spain .
4
4 General Surgery Department, Fundacion Jimenez Diaz Hospital , Madrid, Spain .

Abstract

BACKGROUND:

The incidence of gram-negative multi-drug-resistant (MDR) infections is increasing worldwide. This study sought to determine the incidence, clinical profiles, risk factors, and mortality of these infections in general surgery patients.

PATIENTS AND METHODS:

All general surgery patients with a clinical infection by gram-negative MDR bacteria were studied prospectively for a period of five years (2007-2011). Clinical, surgical, and microbiologic parameters were recorded, with a focus on the identification of risk factors for MDR infection and mortality.

RESULTS:

Incidence of MDR infections increased (5.6% to 15.2%) during the study period; 106 patients were included, 69.8% presented nosocomial infections. Mean age was 65 ± 15 years, 61% male. Extended-spectrum β-lactamases (ESBL) Escherichia coli was the most frequent MDR bacteria. Surgical site infections and abscesses were the most common culture locations. The patients presented multiple pre-admission risk factors and invasive measures during hospitalization. Mortality was 15%, and related to older age (odds ratio [OR] 1.07), malnutrition (OR 13.5), chronic digestive conditions (OR 4.7), chronic obstructive pulmonary disease (OR 3.9), and surgical re-intervention (OR 9.2).

CONCLUSION:

Multi-drug resistant infections in the surgical population are increasing. The most common clinical profile is a 65-year-old male, with previous comorbidities, who has undergone a surgical intervention, intensive care unit (ICU) admission, and invasive procedures and who has acquired the MDR infection in the nosocomial setting.

KEYWORDS:

ESBL; multi-drug resistant (MDR) bacteria; surgery; surgical infections

PMID:
28475416
DOI:
10.1089/sur.2016.255
[Indexed for MEDLINE]

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