The influence of antibiotics usage on extended-spectrum β-lactamase-producing enterobacter colonization among intensive care unit patients

Abstract

BACKGROUND: The prevalence of extended-spectrum beta-lactamases (ESBLs)-producing Enterobacteriaceae has increased throughout the world and is a major cause of treatment failure in intensive care unit (ICU). ESBL-producing Enterobacteriaceae exhibit resistance to cephalosporins which is one of the most commonly used and effective group of antibiotics. AIM: The goal of this study was to identify the variables that influence the colonization of Enterobacteriaceae in patients treated at ICU. PATIENTS AND METHODS: A prospective study involving randomized 70 patients was conducted at ICU of Sanglah General Hospital from October 2018 to March 2019. Specimens were obtained from rectal swabs on admission to and discharged from ICU. Initial bivariate analysis was conducted using Pearson’s Chi-square and considered significant if p <0.05. Adjusted relative risk ratio (RR) was used to estimate the influence of the variables to ESBL colonization. RESULTS: Respiratory system dysfunction (p = 0.012, RR = 2.828) and antibiotic prescription before ICU admission (p < 0.001) influence ESBL-producing Enterobacteriaceae colonization on patient who was admitted to ICU. On discharged from ICU, ESBL colonization was associated to respiratory system dysfunction (p = 0.008, RR = 1.987), third-generation cephalosporin usage (p = 0.009, RR = 2.909), cefoperazone prescription (p < 0.001, RR = 8.471), ceftriaxone prescription (p = 0.007, RR = 6.316), and antibiotics usage duration ≥3 days (p < 0.001, RR = 7.071). The logistic regression results on influence of antibiotics usage and respiratory system dysfunction to ESBL colonization rate shows that both variables are independent risk factor to EBLS colonization both on admitted to and discharged from ICU. CONCLUSION: The antibiotics usage and respiratory system dysfunction are independent risk factors to EBLS colonization in ICU patients.