Prevalence and mortality associated with multidrug-resistant infections in adult intensive care units in Argentina (PREV-AR)
Authors: Cornistein Wanda , Balasini Carina , Nuccetelli Yanina , Rodriguez Viviana M. , Cudmani Norma , Roca Maria Virginia , Sadino Graciela , Brizuela Martín , Fernández Analía , González Soledad , Águila Damián , Macchi Alejandra , Staneloni Maria Inés , Estenssoro Elisa ,   Prevar Study Group, Manzo Alexis , Hualde Mariana , Saavedra Anahi , Ruiz Horacio , Alo Veronica , Guzzi Leda , Hinojosa Mirian , Christin Martin , Villarejo Fernando , Kumar Liliana , Raffo Carla , Correa Silvia , Osuna Carolina , Chamorro Marta , Centeno Pablo , Canelon Roger , Vissani Lucia Tatiana , Blasco Miguel Angel , Izquierdo Hector , Chavez Mariela , Lucía Vissani , Resente Cristian , García Laura , Flores María Florencia , Casso Rodolfo Rodríguez , Novarese Viviana , Magiantini Silvia , Boschi Analía , Costa Marilín Sonia Julieta , Flores Claudia Raquel , Medrano Maira , Camino Juan Cruz , Alvarez Yanina , Seijo María Soledad , Benitez Carlos , Gaudenzi Florencia , Lambert Sandra , Espinola Lidia , Langard Mariana , Comas Marisabel , Cinquegrani Karina , Amundarain Edgar , Muñoz Lucía , Menendez Maria Fernanda , de Aguilar Laura , Sagasta Hernan , Greco Déborah , Salazar Carolina , Ferrucci Gladys , Crotti Patricia , Lafosse Diego , Laffont Carolina , Yantorno Maria Laura , Greco Maria Marta , Finocchio Maria de los Angeles , Tvardek Tamara , Lopez Marta B , Arrigoni Carlos , Nolis Natalia , Sánchez Patricia , Berdiñas Verónca , Fantoni Natalia , Turano Silvana , Aguayo Lys Griselda , Protto Catalina , Loayza Juan , Costa Rosana Lidia , Santillan Patricia , Corral Rodrigo , Artillo Agustina , González Edson , Re Wanda , Orliacq Daniela , Marina Griselda , Culaciati Antonela , Tolosa Micaela , Cuitiño Mario , Bustamante Aldana , Martiren Soledad , Hualde Mariana , Bechini Florencia , Miglioranza Cristina , Pérez Gabriel , Romani Adriana , Lopez Horacio , Ramos Claudia , del Hierro Kevin , Poggio Juan Martín , Baldoni Nadia , Vilca JacKeline , Lares Mónica , García Cecilia , Loudet Cecilia , Bernan Marisa , Suárez Mariana , Connena Walter , Rodríguez Pablo , Pereyra Roberto , Sosa Bruno , Rojas Federico , Romano Roxana , Gilli Marcela , Vilariño Marcela , Mauro Josefina , Luengo Candela , Silva María Elena , Pessacq Pedro , Castelluccio Pablo , Ducatenzeiler Laura , Aquije Carolina , Mañez Noelia , Arguello Facundo , Huaier Emilio Felipe , Racero Laura , Luluaga Juan Pablo , Cerdá Paula , Greco Débora , Serio Enrique , Mastruzzo María , Villa Silvia , Mesplet Florencia , Tosello María Fabiana , Mattia Cristian Jorge , Maurizi Diego , Torres Violeta , Valle Marisol , Tonetto Ivana , Olivero Lorenzo , Varrenti Nicolás , Gil Pablo , Sillitano Silvio , Casanova María , Canosa Nancy , Agustín Pablo , Laplume Diego , Fernández Adriana , Benedetti Fernanda , Freire Verónica , Aime Jimena , Lozano Florencia , Tamponi Lucía , Spadaro María Laura , Guido Susana , Casaretto María Agustina , Perez Johanna Juddith , Nano Maria de las Mercedes , Lachat Ana , Beveraggi Patricia , Ainbender Ailín , López Marianela , Galache Viviana , Paredes Yasmin Luz , Cohen Pablo Martín , Villahermosa Brito , Monzon Magali Elisabet , Garcia Mariel Ayelén , Ortega Javier Julian , Wekselman Silvia , Ruarte Leslie , Reyes Viviana , Nano Mercedes , Nuñez Endrick , Novau Andrea , Cuello María de los Angeles , Steer Carlos , Pratesi Pablo , Desse Javier , Cabrera Rafael , Ortiz Marcelo , Rodríguez Sandra , Farías Celeste , Malvido Joé María , Domínguez Sofia , Fernández Patricia , Zerda Norma Haydee , Sánchez Rosa , Matsuda Mariana , Lamonica Carolina Inés , Larrosa Yanina Elizabeth , Salazar Jorge Luis , Machare Pedro , Aramayo Norma , Carril Romina , Cardinali Paolo , Cuatro Bárbara , Vera Lara , Palermo Mariana , Casandra Tamara , Gallini Oscar , Balda María Marta , Pattere Ayelén , Suchowierchia Nadia , Montefiore Jorge Pablo , Angeletti Virginia , Corsiglia Luis , Galloso Claudia , Macchi Alejandra , Bomparola Daniela , Risso Alejandro , Quinteros Mónica , Quirós Rodolfo , Núñez Hernán , Aversa Clara Irina , Budrovich Laura , Pereyra Cecilia , García Fabiana , Garcés Fernández , Luque Noelia , Falcon Nicolás David , Rodríguez Pablo , Areco Lucia , Deheza Martín , Gelvis José , Zitto Teresa , Eleizeri Adrián , Baiona Gastón , Palizas Fernando , Ruiz Agustina Paula , Aguirre Leandro , Klein Francisco , Tuhay Graciela , Perez Luis Carlos , Tavella Margarita , Racioppi Agustina , Irrazabal Cecilia Leonor , Camporro Julieta , Escarra Florencia , Hlavnika Alejandro , Costales Gustavo , Mora Andrea , Carbone Edith , Audelina Ramos , Picolla Virginia , Herrera Carolina , Jacob Néstor , Ramos Guillermo , Braña Enriqueta , Gelmi Paula , Della Bianca Gabriela , Dufrand Laura , Lemos Silvia , Jordan Rosana , Verbanaz Sergio , Martinez Jorge Victor , Giorgio Patricia , Eusebio María José , Colque Ángel , Torres Melisa , Quaranta Darío , Aphalo Vanina , Irrázabal Celica , de Gregorio Stella , Alvarez Carla , Mancino María Belén , Sisto Alicia , Piombi Santiago , Vega Julian , Vega Julian , Zerega Pablo , Apablaza Candela , Sanchez Marisa del Lujan , Smud Astrid , Nemirovsky Corina , de Paz Mariana , Stanek Vanina , Di Stefano Sabrína , Gadea Rosana , Portilla Diana , Cunto Eleonora , Chediack Viviana , Rodriguez Alejandra , Saúl Pablo , Flores Marco , Margari Alejandra , Nina Ana , Vera David , Adra Mariel , Valiño Araceli , Vilalovos Micaela , Sirino Alicia Beatriz , Healy Sean , Argana Wendy , Costa María Fernanda , Yahni Diego , Vasta Leonardo , Angiono Antonela , Richeri Esteban , Bracamonte Lorena , Espina Mariana , Garcia Sebastian , Baratelli Martin , Villa Silvia , Coronel Antonio , Santillán Patricia , Hernandez Cindy Julieth , Patricia García , Patricia Constantini , Pujato Natalia , Manquez Adriana , Galian Santiago , Nolis Natalia , Manchado Agustin , Misa María Andrea , Rivero Edgardo Bautista , Salgueira Claudia , Tatta Melisa , Inda Laura , Cardenas Violeta , Sanchez Carla , Salcedo Elvis , Crosetti Susana , Lescano Adrian , del Valle Cecilia , Areso Soledad , Paz Verónica , Alzola Rodrigo , Garibaldi Franco , Vera Cecilia , Somani María Inés , Torres Diego , González Soledad , Echavarría Gonzalo , Colombini Ana Carolina , Marchena María Cecilia , Báez Adriana , Musante Romina , Latini Verónica , Berté Mariana , Ruíz Mariquena , Vazquez María Belén , Oyola Carolina , Bordón Lucas , Ponce Claudia , Bulacios Mario , Farias Juan , Romero Ceferino , Silvia Wekselman , Levite Julieta , Oliva Emilse , Mussini Soledad , Hellriegel Bárbara , Cusin Viviana , Azocar Ariel , Roca María Virginia , Pezzi Silvana , Fretes Sandra , Roberto Maikon , Ríos Carla , Thomas Ruth Viviana , Virginia María , Toledo Norma , Pezzi Silvana , Julian Javier , Wekselman Silvia , Ruarte Leslie , Trucchia Rosana , Pagliarone Jonathan , Perez David Agustín , Verónica Andrea , Theaux María Virginia , Lipari Flavio , Brito Ruth , Montamat Mariana , Nelli Sofia , Zucotti Melisa , Spitale Natalia , Spada Francisco , Villamandos Silvina , Mariano Leonardo , Peña Laura , Reggiardo María del Pilar , Cornejo Ludmila Anabel , Azar Virginia , Bourlot Ignacio , Etchegoyen Dalila , Mainez Micaela , Benítez Natalia , Petenatti Cecilia , Ríos Pablo , Prieto María Florencia , Ferreyra Mónica , Dodorico Mauro , Kriger Sonia , Wei Liu , Escobar Pedro , Ruiz Evelyn Rocío , Tejerina Susana , Rodriguez Ana Elizabeth , Yañez Micaela , Cabana Laura , Sánchez Ana , Fernández Natalia , Perera Pablo , Gallego Paula , Saluzzo María de los Angeles , Sosa Irene , Baroni Andrea Beatriz , Mateos Laura Paola , Reyes Nahir , Acosta Marinela , Cardone Romina , Jose Centorbi , Graciela Ponce , Arreghini Valeria , Fernandez María Felicitas , Marengo Marcos , Cabral Myrna , Martinez Betina , Rivero Cynthia , Jahan Cintia , Turchetto Elsio , Cassata Andrea , Méndez Gustavo , Ribak Sergio , Marton Victoria Isabel , Compañy Lucia , Linda B , Kuo Lien , Grana Patricio , Herrero Malena , Naum Jorge , Cevoli Valeria , Traba Mario , Ulzurrun María Laura , Durany Daniela , Noelia Carola Curunao , Diaz Lucrecia , Medoni Antonella , de Bunder Sabrina , Pincheira Carolina , Andrade Blanca , Escalada Andrea , Leona Lorena , Torres Emma , Falco Adriana , Lopez Beatriz , Giménez Laura , Giménez Laura , Delgado Lucía , Rosana Solano , Norma Sponton , Perez José Manuel , Aragona Elizabeth , Ramírez Violeta , Cuello Alejandra , Chirino Karina , Elias Daniel , Bonetto Miguel , Figueroa Alvaro , Iglesias Tatiana , Olivares Fernando , Torres Andres , Bertoluzzi Emiliano , Vaca María Cristina , Ambroselli Pablo , Fornero Paola , Galati María Florencia , Urbinati Paula Gabriela , Saez Daniel , Rucci Victoria Emeli , Gomez María Georgina , Simil Fernando , Morera Graciana , Marta Filippi , Adriel Armandola , Tamagno Gilda , Bettini Lisandro Roberto , Liernur Miguel Angel , Vergara Silvina , Ferrer Maria Fernanda , Luján Silvia , Maurino Julia , Canteli Constanza , Aleman Julia , Cappello Sandra , Díaz Bernardette , Platini Delfina , Natalia Pairetti , Bonifacio Ainalen , Soli Silvana , Rucci Victoria , Stelzer Marcos , Florencia María , Dodorico Mauro , Ferreyra Mónica , Lovesio Luciano , Mattio Carla , Espinel Diego , Benavent Gustavo , Digiorg Marcela , Vega Edgar , Rodríguez Lorena , Basombrio Adriana , Cabrera Carla , Olivo Luz María , Galvez Noelia , Arriola Luisa Fernanda , Chacana Patricia , Jorge Noelia , Guardia Luis Jeronimo Esteban , Avila Luis Rubén , Cabrera Maria Pilar , Cecchin Cecilia Yanina , Gallo Ricardo Fabián , Flores Silvia Andrea , Morales Silvia , Reinoso Soledad , Rodríguez Mariana , Nastar Valeria , Araoz Benjamin , Logwiniuk Carlos , Figueroa Natalia , Palacios Melani , VillafaÑe Sandra Elizabeth , Ramacciotti Jorge , Puchulu Magdalena , UrueÑa Maria Alejandra , Lazarte Romina Paola , Acosta María Evelin , Martínez Cintia , Nieva Matias , Deheza Armando , Vizcarra Carlos , Maldonado Mercedes , Farhat Alejandra , Araoz Benjamin , Caba Samanta , Lavarra Enzo , Arancibia Celeste 
Published: January 2025

ABSTRACT

Data from low and middle-income countries (LMICs) on multidrug-resistant microorganisms (MDROs) in intensive care units (ICUs) are scarce. Working in several ICUs in Argentina, we sought to estimate the prevalence and characteristics of MDRO infections and carbapenemase-producing Enterobacterales (CPE) colonization. Mortality associated with MDRO infection was also evaluated. The study was a 24-hour point prevalence study conducted in 164 adult ICUs in Argentina between 24 November and 28 November 2023. The main study outcome was in-ICU mortality and secondary outcomes included the prevalence of MDRO infections, the prevalence of CPE colonization (defined as CPE recovered from a rectal swab), and ICU length of stay (LoS). Mixed effects modeling was used to identify risk factors for in-ICU mortality. Among 1,799 patients, 933 (51.9%) had a reported infection; 599 infections (64.2%) were classified as definite (i.e., with positive cultures) and 334 (35.8%) as probable infection (i.e., negative cultures but signs of infection). Of the 933 patients with infection, 273 (29.2%) had an MDRO recovered with 344 total MDRO cultures recovered. Non-MDRO was recovered from 326 (34.9%) of the 933 patients. Among definite infections, 45.5% (273/599) were due to MDRO with an overall prevalence of MDRO of 15.1% (273 patients with MDRO infections/1,799 patients). CPE colonization, defined as a positive rectal swab taken during the incident hospitalization, occurred in 420/1,696 (24.7%) patients. The most frequent MDRO infection was ventilator-associated pneumonia (100/344; 29.1%). The most common MDRO recovered were carbapenem-resistant
Acinetobacter baumannii
and CPE (98/344, 28.5% each). In-ICU mortality was 27.1% (487/1,799); independent predictors were age (odds ratio [OR] 1.01 [1.00–1.02],
P
= 0.003), MDRO infection (OR 1.65 [1.18–2.43],
P
= 0.012), probable infection (OR 1.41 [0.97–2.04],
P
= 0.073), sepsis-related organ failure assessment (SOFA) score (OR 1.18 [1.13–1.23],
P
= 0.000), and hospital-acquired pneumonia (OR 1.84 [1.12–3.01],
P
= 0.016). Mortality also varied significantly by hospital (
P
< 0.001). LoS was significantly longer in patients with MDRO infections, 30.0 (interquartile range [IQR] 17–35) days vs 16.0 (IQR 8–33) in non-MDRO,
P
< 0.0001. Among 1,799 ICU patients in an LMIC, the prevalence of MDRO infection and CPE colonization was high. The presence of an MDRO infection was associated with increased mortality and prolonged ICU LoS.

CLINICAL TRIALS

This study is registered with

ClinicalTrials.gov
as
NCT06574776

.