P-109 Multidrug resistant bacteria (MDRB) and bed turnover: is it true that the fragile patient should be moved the least possible?

• Published in: Sexually transmitted infections Vol. 100; no. Suppl 1; pp. A217 - A218
• Main Authors: Fanelli, C, Pistidda, L, Are, R, Pasero, D
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.06.2024; BMJ Publishing Group LTD
• Subjects: Antibiotics; Bacteria; COVID-19; Drug resistance; Mortality; Multidrug resistant organisms; Patients
• ISSN: 1368-4973; 1472-3263
• DOI: 10.1136/sextrans-ICAR-2024.200

BackgroundMultidrug resistant bacteria (MDRB) are a major threat to Intensive Care Unit (ICU) patients. Beds cleaning is a key factor in infection prevention and control (IPC). Our aim was to investigate whether bed turnover could affect the quality and prevalence of MDRB.Materials and MethodsWe conducted a retrospective study on patients hospitalized between the 1rst November 2023 and the 30th January 2024 in our 23-beds-ICU, Sassari, Italy. They are divided in those dedicated to medical (n.1–7), surgical (n.11–15), and COVID-19 (n.20–24) patients. All other beds (9, 10, 16, 17, 18, 19) are for isolation. Bed turnover, MDROs findings, patient’s outcome and length of ICU stay (LOSICU) were analyzed.ResultsOverall, 137 bed occupants were identified in the study period (table 1).Of them, 24 (17.5%) were Klebsiella pneumoniae carbapenemase-producing (KPC) bacteria carriers, 23 (17.5%) were Acinetobacter baumanii (AB) carriers, and 18 (13.1%) Vancomycin Resistant Enterococci (VRE) carriers in at least one between rectal, blood, urine or respiratory samples.All of them were more commonly co-present with each other (KPC 14/26, 53.8%; AB 14/24, 58.3%; VRE 12/20; 60%) rather than alone. The most common association was AB+KPC (7/19, 36.8%), followed by AB+VRE (5/19, 26.3%), KPC+VRE (4/19, 21.1%), and AB+KPC+VRE (3/19, 15.8%).Surgical beds had the greatest turnover (10–13 patients in 3 months), accounting for the majority of patients (60/137, 43.8%), followed by medical ones (8–5 patients in 3 months, 45/137, 32.9%), and isolation ones (5–2 patients in 3 months, 20/137, 14.6%).Most beds carrying MRDB patients were medical (18/43, 41.7%), and not isolation beds (16/43, 37.2%). KPC- and AB- alone carriers were mainly identified in medical beds (60% and 50% of the total), while VRE-alone carriers were equally distributed with the exception of isolation beds (0/6). Considering associations, AB+VRE was prevalent in medical (3/5, 60%), and isolation beds (2/5, 40%), while AB+KPC in isolated patients (5/7, 71.4%).The LOSICU in AB carriers (mean 51 ±23 days) was superior compared to non-AB carriers (15 ± 13 days) in all beds with ≥2 AB carriers. Death rate was 31.4% in average, reaching 58.3% of COVID-19 beds, 45% in isolation beds (9/20), and 40% in medical beds (18/45). Most deaths took place in medical beds (9/43, 20.9%). Mortality was higher in AB+KPC+VRE carriers (66.6%), and AB-alone carriers (50%). KPC-alone, KPC+VRE and AB+VRE showed the same mortality rate (40%), followed by VRE-alone (33.3%). AB+KPC had the lowest mortality rate (14.3%).ConclusionsOur data suggest that medical beds are subject to higher AB carrying and mortality compared to patients in isolation beds, surgical and COVID-19 beds.This study provides a hint for intensivist for not to underestimate IPC measures in non-isolated medical patients.Abstract P-109 Table 1ICU beds’ occupants MDRB findings, mean length of ICU stay (LOSICU) and associated mortality