Epidemiology of XXXX and risk factors for carriage acquisition in an intensive care unit.

@entity1 @entity281 @entity694 @entity796
Because of a high prevalence of @entity796 @entity281 , we conducted an epidemiological study to assess the need for systematic surveillance, as well as the value of applying barrier precautions toP. aeruginosa carriers. From July 1997 to February 1998, we conducted a prospective cohort study in an 18-bed medical intensive care unit (ICU), which is part of the infectious diseases department in a 1200-bed tertiary-care teaching hospital. Rectal and oropharyngeal swabs were obtained on admission and twice weekly. Acquired strains were genotypically characterized by pulsed-field gel electrophoresis (PFGE). A risk factor analysis for carriage, colonization and @entity281 was performed. Among 269 eligible @entity1 , 116 (43%) were @entity796 carriers, with 46 (17%) detected on admission and 70 (26%) who acquired carriage during their stay in ICU. Among these 70 @entity1 , 29 became colonized (N=13) or developed @entity281 (N=16). Conversely, in the 121 @entity1 who remained free of carriage, no @entity694 were detected. Genotyping analysis using PFGE was performed for 81/85 (95%) acquired strains in 67 @entity1 . The same genotype I was observed for 58/81 (70%) of these strains issued from 47 @entity1 , and a distinct genotype II affected two other @entity1 (three strains). The last 20 strains were not genetically related. In a multivariate model, mechanical ventilation was associated with the acquisition of P. aeruginosa carriage. Antibiotics ineffective against @entity796 significantly increased the risk of @entity694 in ICU. Although several recent studies concluded that endogenous sources account for the majority of @entity796 colonizations or @entity281 , we conclude that epidemiology may vary according to the ICU, and that cross-colonization (i.e., exogenous source) may occur and warrant reinforced barrier precautions.
