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Factores de riesgos relacionados a la mortalidad por enterobacterias resistentes a carbapenémicos : estudio caso-control.

Abstract:

BACKGROUND: Carbapenem-resistant Enterobacteriaceae (CRE) represent a growing problem. They have a high potential for spreading in health units and have been associated with high morbidity and mortality rates. METHODS: A case-control study of patients (> 18 years old, admitted> 48 hours in ICU) was carried out in a tertiary level Hospital in Guayaquil. The cases had positive cultures for CRE. The controls had negative cultures for CRE. A retrospective analysis was carried out. RESULTS: 80 deceased patients were found, 34 (42.5%) were infected / colonized with CRE. There is no statistical significance between sex and CRE infection (p = 0.051). The average age of the group of patients with CRE was 62.47 ± 21.39 and in patients without CRE was 58.97 ± 20.15 (p = 0.458). The average number of days in ICU of patients infected with CRE is 26.91 days and in patients without CRE it is 13.82 days (p = 0.01). By means of the logistic regression model, the variable cardiovascular disease as a base disease is significant with 95% confidence (p = 0.022). Among the risk factors related to CRE were tracheostomy and surgery (p = <0.05). Around 68.5% (55/80) of the deceased, and 32.5% (26/34) colonized / infected with CRE received antimicrobials before their first isolation. Vancomycin was the most prevalent, around 23.5% in patients with CRE. Only 32.4% (11/34) of patients with CRE received adequate antimicrobial treatment. CONCLUSIONS: The presence of CRE did not relate with sex, age, apache. While, the prolonged stay in ICU, invasive procedures such as tracheostomy and surgery if they were related with CRE. Vancomycin was the precursor antimicrobial most prevalent in patients with CRE. The majority of patients with CRE did not receive adequate treatment,