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Background <p>Postoperative gastric cancer patients requiring intensive care unit (ICU) management are vulnerable to healthcare-associated infections, including multidrug-resistant organism (MDRO) infections. Evidence defining ICU-specific clinical risk factors in this population remains limited.</p> Methods <p>This retrospective cohort study enrolled consecutive adult patients with pathologically confirmed gastric cancer who underwent gastrectomy and required postoperative ICU care between June 2022 and June 2025. MDRO infection was defined by concordant clinical infection features and microbiological confirmation with isolates demonstrating acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Demographic characteristics, comorbidities, perioperative variables, ICU therapies, prior antibiotic exposure within 90 days, and admission laboratory indices were collected. Between-group comparisons and univariate and multivariable logistic regression analyses were performed.</p> Results <p>Of the 216 included patients, 51 were classified into the MDRO infection group and 165 into the non-MDRO infection group. Pulmonary infection was the most frequent clinical type, followed by intra-abdominal/surgical site, bloodstream, and urinary tract infections. Resistant Gram-negative organisms predominated, led by extended-spectrum β-lactamase–producing Enterobacterales, carbapenem-resistant <i>Acinetobacter baumannii</i> (CRAB), carbapenem-resistant Enterobacterales, and carbapenem-resistant <i>Pseudomonas aeruginosa</i>. In multivariable analysis, older age (OR 1.04 per year), diabetes mellitus (OR 1.86), intraoperative blood loss (OR 1.49 per 100 mL), anastomotic leakage (OR 3.06), mechanical ventilation (OR 1.79), higher Acute Physiology and Chronic Health Evaluation II score (OR 1.12 per point), and prior antibiotic exposure within 90 days (OR 2.16) were independently associated with MDRO infection, whereas higher admission albumin was inversely associated (OR 0.92 per g/L). Sensitivity analyses yielded consistent results.</p> Conclusions <p>In postoperative gastric cancer ICU patients, ICU-acquired MDRO infections were common and predominantly Gram-negative, with respiratory and intra-abdominal foci. A combined profile of baseline vulnerability, operative burden, ICU severity, and recent antibiotic exposure was associated with MDRO infection risk, supporting risk stratification and targeted preventive and stewardship strategies.</p> Clinical trial number <p>Not applicable.</p>

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Clinical risk factors for multidrug-resistant organism infections in postoperative gastric cancer patients: an ICU-based retrospective analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月25日

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  • Ping Yao,
  • Jiao-Long He,
  • Peng-Fei Yang,
  • Xiao-Jing Jiang,
  • Yu-Kun Li,
  • Zhi-Min Wei

摘要

Background

Postoperative gastric cancer patients requiring intensive care unit (ICU) management are vulnerable to healthcare-associated infections, including multidrug-resistant organism (MDRO) infections. Evidence defining ICU-specific clinical risk factors in this population remains limited.

Methods

This retrospective cohort study enrolled consecutive adult patients with pathologically confirmed gastric cancer who underwent gastrectomy and required postoperative ICU care between June 2022 and June 2025. MDRO infection was defined by concordant clinical infection features and microbiological confirmation with isolates demonstrating acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Demographic characteristics, comorbidities, perioperative variables, ICU therapies, prior antibiotic exposure within 90 days, and admission laboratory indices were collected. Between-group comparisons and univariate and multivariable logistic regression analyses were performed.

Results

Of the 216 included patients, 51 were classified into the MDRO infection group and 165 into the non-MDRO infection group. Pulmonary infection was the most frequent clinical type, followed by intra-abdominal/surgical site, bloodstream, and urinary tract infections. Resistant Gram-negative organisms predominated, led by extended-spectrum β-lactamase–producing Enterobacterales, carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Enterobacterales, and carbapenem-resistant Pseudomonas aeruginosa. In multivariable analysis, older age (OR 1.04 per year), diabetes mellitus (OR 1.86), intraoperative blood loss (OR 1.49 per 100 mL), anastomotic leakage (OR 3.06), mechanical ventilation (OR 1.79), higher Acute Physiology and Chronic Health Evaluation II score (OR 1.12 per point), and prior antibiotic exposure within 90 days (OR 2.16) were independently associated with MDRO infection, whereas higher admission albumin was inversely associated (OR 0.92 per g/L). Sensitivity analyses yielded consistent results.

Conclusions

In postoperative gastric cancer ICU patients, ICU-acquired MDRO infections were common and predominantly Gram-negative, with respiratory and intra-abdominal foci. A combined profile of baseline vulnerability, operative burden, ICU severity, and recent antibiotic exposure was associated with MDRO infection risk, supporting risk stratification and targeted preventive and stewardship strategies.

Clinical trial number

Not applicable.