An investigation of the risk factors of the health-care associated infections associated with extended-spectrum beta-lactamase producing microorganisms in Karadeniz Technical University Faculty of Medicine Hospital

Risk factors for ESBL producing microorganisms in healthcare-associated infections (HCAI) consisting of microorganisms of the family Enterobacteriaceae were investigated prospectively between 01 January and 31 December, 2008, at the Karadeniz Technical University Faculty of Medicine Farabi Hospital. A total of 32941 patients and 982 HCAI were investigated. Total HCAI rate was 2.98 and HCAI density per 1000 patient hospitalization days was calculated at 4.77. Two hundred seventy-three (%27.8) of the 982 HCAI consisted of microorganisms from the family Enterobacteriaceae. Two hundred thirty-six HCAI meeting our inclusion criteria were accepted for analysis and 37 excluded. One hundred twenty-six HCAI (%53.4) consisted of ESBL (+) and 110 (%46.6) of ESBL (-) microorganisms.At univariate analysis, wound/soft tissue infection (p=0.005; OR=3.64), admission to surgical departments (p=0.006; OR=2.41), urologic pathology (p=0.008; OR=3.06), previous hospitalization (p<0.0005; OR=3.32), previous surgery (p<0.0005; OR=2.99), previous antibiotic use (ceftriaxone, ciprofloxacin, amikacin or metronidazole) (p<0.0005; OR=31.16) and invasive procedures (p=0.003; OR=2.98) were identified as risk factors increasing ESBL production. At multivariate analysis, pulmonary disease (p=0.035; OR=2.80), invasive procedures (p=0.003; OR=4.36) and previous antibiotic use (ceftriaxone, ciprofloxacin or amikacin) (p<0.0005; OR=29.90) were identified as independent ESBL-associated risk factors.In conclusion, a large number of largely preventable risk factors affecting ESBL production were identified, headed by previous antibiotic use. The possibility of ESBL in patients with one or more of these risk factors must be borne in mind in selecting treatment, and risk factors should be eliminated.