Early trajectories of antibiotic exposure and colonization pressure and risk of ICU-acquired carbapenem-resistant Gram-negative bacteria: A prospective cohort study
Authors' conclusion
This study identified distinct early trajectories of antibiotic exposure and colonization pressure that were associated with differential CR-GNB acquisition risk.
Study context
- Population
- Consecutive ICU patients with systematic rectal surveillance cultures, four intensive care units (ICUs) of a tertiary-care center in China, March 2024 to January 2025Day-5 landmark analysis
- Participants
- 533 patients
- Exposure
- Early joint trajectories of antibiotic exposure and colonization pressure (first 5 ICU days): escalating exposure/intermediate pressure and high exposure/high pressure vs low exposure/low pressure
- Outcome
- ICU-acquired carbapenem-resistant Gram-negative bacteria (CR-GNB)
- Follow-up
- After Day 5
Methodological detailsgroup-based multi-trajectory modeling, continuous-time Markov multi-state models, Day-5 landmark analysis, four ICUs, single tertiary-care centre
- Group-based multi-trajectory modeling
- Continuous-time Markov multi-state models
- Day-5 landmark analysis
- Four ICUs, single tertiary-care centre
Main finding
As reported in the abstract
ICU-acquired CR-GNB after the Day-5 landmark
Adjusted hazard ratio (95% CI)P value
Escalating-exposure vs Low-exposure
1.68(1.24–2.28)
P < 0.001High-exposure vs Low-exposure
2.82(1.53–5.19)
P < 0.001- Overall Carbapenem-resistant Gram-negative bacteria (CR-GNB) acquisition
- 124 (23.3%)
Observational data: associations, not effects.
Original publication
Early trajectories of antibiotic exposure and colonization pressure and risk of ICU-acquired carbapenem-resistant Gram-negative bacteria: A prospective cohort study. Ann Intensive Care. Published 6 April 2026. doi:10.
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