MDR colonization: what ́s the matter in the perioperative setting?

INTRODUCTION. Multi-Drug-Resistant (MDR) colonization is an actual major issue in intensive care units (ICUs) and perioperative medicine, frequently resulting in life-threatening infections. OBJECTIVES. The aim of this study was to evaluate the post- operative course of patients requiring ICU admission after surgery and to compare MDR colonized patients (pts) undergoing abdominal surgery to non colonized ones. METHODS. We retrospectively analyzed all consecutive patients undergoing surgery in our hospital for a three-month period (July- September 2017) who required admission to our 12-bed-medico- surgical ICU on post-operative day (POD) 0 (Dept Anesthesia and Intensive Care B, Policlinico GB Rossi). We then compared MDR col- onized (rectal and/or pharyngeal swab) patients (MDR+) to non col- onized patients (MDR-) for post operative complications, ICU and hospital length of stay (LOS) and mortality. We also investigated the impact of administered targeted perioperative antibiotic ther- apy compared to empiric antibiotic prophylaxis. RESULTS. 70 pts were included in the study (47 men), median age 67(55-79) years; they underwent either elective (n=57, 81.4%) or emergency (n= 13, 18.6%) surgery; 33 pts (47.1%) were submitted to pancreatic surgery, 15 (21.4%) to intestinal resection, 13 (18.6%) to hepato-biliary surgery, and the rest to other kind of abdominal sur- gery; they were admitted to ICU on POD 0 for scheduled (n =52, 74,3%) or unscheduled (n= 18, 25,7%) intensive PO monitoring. These latter were admitted because of surgical length (10, 4.9%), sep- tic episode (4, 5.7%), intraoperative hypotension (2, 2.9%) , intraoper- ative hemorrage (2, 2.9%). 11 pts were MDR+ pre operatively (15,7%), 4 of whom were either Klebsiella Pneumoniae Carbapenemasis Producer or Vancomycin Re- sistant Enterococcus (VRE) colonized and 7 pts were Extended Spectrum Beta Lactamase (ESBL) Escherichia Coli colonized. Both ICU and hospital LOS were significantly higher in MDR+ compared to MDR- (16±23 vs 2±3 and 37±25 vs 22±16, respectively, p < 0.05). Hospital mortality occured in 4 patients, all MDR+ (p< 0.001). Postop- erative complication incidence and type did not significantly differ between the two groups. 4 MDR+ patients (5.7%) received targeted pre-operative antibiotic therapy compared to standard prophylaxis but this did not influence their outcome (small number). CONCLUSIONS. Pre-operative surveillance swab positivity correlates with both ICU and hospital LOS and post-operative mortality, no matter swap and surgical sites. Targeted antibiotic therapy may be routinely used to improve patients' outcome. More studies are needed to further investigate the possibile therapeutic options in MDR+ patients undergoing surgery.