Introduction:

Extended spectrum beta-lactamases (ESBL) produced by gram-negative bacteria have been associated with increased hospital morbidity and mortality, longer hospital stays, use of carbapenems, and higher health care costs. Few studies have assessed the risk factors for infection by ESBL-producing germs in intensive care units (ICU).

Objective:

To determine the risk factors for healthcare-associated infections (HAIs) by ESBL-producing Klebsiella pneumoniae and Escherichia coli in an ICU of a public tertiary care hospital and to assess the impact of this type of infection on mortality.

Materials and methods:

A case-control study with a 1:2 ratio (97 cases and 194 controls) was conducted in critically ill patients admitted to the ICU of a public tertiary care hospital in Bogotá D.C. (Colombia) between January 2016 and December 2019, and in which a HAI by ESBL-producing K. pneumoniae or E. coli (cases: n=97) or K. pneumoniae or E. coli with a normal antibiotic resistance pattern (controls: n=194) was documented. Bivariate analyses were performed using the chi-squared and the Mann-Whitney U tests. A logistic regression model was used in the multivariate analysis, and a two-tailed test was performed with the p-values obtained in the bivariate analyses.

Results:

ESBL-producing K. pneumoniae and E. coli isolates were identified in 57 (58.76%) and 40 (41.24%) patients, respectively. These isolates were obtained mainly from urine samples (30,92%), followed by peritoneal fluid (27.80%). In the multivariate analysis, the presence of urinary tract infection on admission to the ICU was identified as a risk factor (OR=5.63, 95%CI: 1.918-16.53;; p=0.002). The mortality rate was 28.17% (26.29% in the controls and 31.95% in the cases), but no significant difference was observed between groups (p=0.311).

Conclusion:

Urinary tract infection on admission to the ICU was a risk factor for HAIs by ESBL-producing K. pneumoniae or E. coli. Furthermore, no significant difference was observed between cases and controls in terms of mortality.

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