Analysis of the predictive value of preventive isolation criteria in the intensive care unit

Abstract

Objective: To assess the diagnostic accuracy of the criteria used to detect patients carrying multiresistant microorganisms (MRMs).

Design: A prospective observational study was carried out from May 2014 to May 2015.

Setting: Polyvalent Intensive Care Unit.

Patients: A cohort of consecutively admitted patients meeting the following criteria for preventive isolation according to the "Zero Resistance" project: hospital length of stay>4 days in the last three months ("hospital"); antibiotherapy during one week in the last month ("antibiotic"); institutionalized patients or recurrent contact with healthcare ("institution or care"); MRM carrier in the last 6 months ("previous MRM").

Variables: Demographic data, culture results and isolation time. A multivariate analysis was performed using multiple logistic regression between each of the risk factors and patient MRM carrier status.

Results: During the study period, 575 patients were admitted, of which 28% met the isolation criteria (162). Fifty-one (31%) were MRM carriers. Of the patients who did not meet the criteria, 29 (7%) were carriers. In the multivariate analysis, the only variable independently associated to carrier status was "previous MRM", with OR=12.14 (95%CI 4.24-34.77).

Conclusions: The only criterion independently associated with the ability to detect patients with MRMs upon admission to the ICU was the existence of "previous MRM".

Keywords: Aislamiento preventivo; Antimicrobial resistance; Bacteria multirresistente; Intensive care unit; Multidrug-resistant bacteria; Pre-emptive isolation; Resistencia antimicrobiana; Unidad de cuidados intensivos.