MULTIDRUG RESISTANT INFECTIONS IN INTENSIVE CARE UNITS

Biljana Jordan Andonovska, Vesna Ilija Kotevska, Alan Goce Andonovski

Abstract


Background: Intensive care units (ICU) are often the epicentre of development of infections caused by multidrug resistant (MDR) organisms.

Purpose: The aim of our study was to determine the prevalence and types of ICU-acquired infections, pathogens associated with such infections and to determine the antibiotic resistance pattern of the presented pathogens.

Material and methods: In the study were included 130 patients hospitalized into the surgical ICU of the University Clinic for Anesthesiology and Intensive Care in Skopje in period of 2 months, April -Jun, 2017. who developed infection after at least 72 hours of their hospitalization. In all of them the pathogens and their antibiotic resistance pattern were identified.

Results: Twenty of 130 (15.4%) patients developed ICU-acquired infection. Most common infections were pneumonia (50%) and surgical site (30%) infections.Gram-negative organisms were more common isolated than Gram-positive organisms (83% vs.17%). The most common isolated bacteria were Acinetobacter species (30, 41.7%) and Pseudomonas aeruginosa (15, 20.8%). All isolated species were MDR organisms resistant to the most used antibiotics like Cephalosporins, Gentamicin, Ciprofloxacin and Clindamycin. Pseudomonas aeruginosa and Acinetobacter species were sensitive to Colistin, Methicillin-resistant Staphylococcus aureus (MRSA) to Vancomycin and Linezolid and Enterococcus only to Linezolid. Klebsiella pneumoniae and Proteus mirabilis showed low resistance only to Amikacin and Carbapenems.

Conclusions: Our study obtained local data about the prevalence and types of ICU-acquired infections, types of pathogens and their antibiotic resistance pattern.Based on this knowledge, clinicians can choose appropriate antibiotics, avoiding antibacterial drug overuse and MDR bacteria development.


Keywords


intensive care unit acquired infections, multidrug resistant bacteria, antibiotic resistance.

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References


Esen S, Leblebicioglu H. Prevalence of nosocomial infections at intensive care units in Turkey: a multicentre 1-day point prevalence study. Scand J Infect Dis. 2004;36(2):144–8.

Ylipalosaari P, Ala-Kokko TI, Laurila J, Ohtonen P, Syrjala H. Epidemiology of intensive care unit (ICU)- acquired infections in a 14-month prospective cohort study in a single mixed Scandinavian university hospital ICU. Acta Anaesthesiol Scand. 2006;50(10):1192–7.

Hotchkiss RS, Monneret G, Payen D. Immunosuppression in sepsis: a novel understanding of the disorder and a new therapeutic approach. Lancet Infect Dis. 2013;13(3):260-8.

Conway Morris A, Datta D, Shankar-Hari M, Stephen J, Weir CJ, Rennie J et al. Cell-surface signatures of immune dysfunction risk-stratify critically ill patients: INFECT study. Intensive Care Med. 2018;44(5):627-35.

Cairns S, Reilly J, Booth M. Prevalence of healthcare-associated infection in Scottish intensive care units. J Hosp Infect. 2010;76(4):308-10.

Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009;302(21):2323-9.

Ylipalosaari P, Ala-Kokko TI, Laurila J, Ohtonen P, Syrjala H. Intensive care acquired infection is an independent risk factor for hospital mortality: a prospective cohort study. Crit Care. 2006;10(2):R66.

Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee. JAMA.1995;274(8):639-44.

McGowan JE. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis. 1983;5(6):1033-48.

Marr JJ, Moffet HL, Kunin CM. Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America. J Infect Dis. 1988;157(5):869-76.

Luyt CE, Brechot N, Trouillet JL, Chastre J. Antibiotic stewardship in the intensive care unit. Crit Care 2014;18(5):480.

Lat I, Daley MJ, Shewale A, Pangrazzi MH, Hammond D, Olsen KM; DEFINE study group and the Discovery Research Network. A multicenter, prospective, observational study to determine predictive factors for multidrug resistant pneumonia in critically ill adults: The DEFINE study. Pharmacotherapy 2019;39(3):253-60.

Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Bruzzi de Carvalho F, et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med 2012;38(12):1930-45.

Cowan S. Cowan and Steel's manual for the identification of medical bacteria. In: Barrow GI, Feltham RKA, editors. Third Edit. Cambridge: Cambridge University Press; 2003.

Ventola CL. The antibiotic resistance crisis: Part 1: Causes and threats. PT. 2015; 40(4):277-83.

Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268–81.

Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, et al. Bad bugs, no drugs: No ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis. 2009; 48(1):1-12.

Ferrer R, Martin-Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: Results from a guideline-based performance improvement program. Crit Care Med. 2014;42(8):1749-55.

Antibiotics Resistance Threat in the US. US Department of Health & Human Services; Centers for Disease Control and Prevention [Internet]. 2013. Available from: http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf

Sanusi AA, Osinaike BB, Fayemiwo SA, Nwadike VU, Akinyemi AO, Adigun TA et al. Epidemiology of bacteria colonization and ICU acquired infection in a Nigerian tertiary hospital. African J Infect Dis. 2015;9(2):61–6.

Rosenthal VD, Guzman S, Orellano PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control. 2003;31(5):291–5.

Meric M, Willke A, Caglayan C, Toker K. Intensive care unit-acquired infections, incidence, risk factors and associated mortality in a Turkish university hospital. Jpn J Infect Dis. 2005;58(5):297–302.

Erbay H, Yalcin AN, Serin S, Turgut H, Tomatir E, Cetin B, et al. Nosocomial infections in intensive care unit in a Turkish university hospital: a 2-year survey. Intensive Care Med. 2003;29(9):1482–8.

Magnason S, Kristinsson KG, Stefansson T, Erlendsdottir H, Jonsdottir K, Kristjansson M et al. Risk factors and outcome in ICU-acquired infections. Acta Anaesthesiol Scand. 2008;52(9):1238–45.

Makanjuola OB, Fayemiwo SA, Okesola AO, Gbaja A, Ogunleye VA, Kehinde AO, et al. Pattern of multidrug resistant bacteria associated with intensive care unit infections in Ibadan, Nigeria. Ann Ib Postgrad Med. 2018;16(2):162–9.

Ponce de León-Rosales SP, Molinar-Ramos F, Domínguez-Cherit G, Rangel-Frausto MS, Vázquez-Ramos VG. Prevalence of infections in intensive care units in Mexico: a multicenter study. Crit Care Med. 2000;28(5):1316-21.

Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol. 2000;21(8):510–5.

Sheth KV, Patel TK, Malek S, Tripathi CR. Antibiotic sensitivity pattern of bacterial isolates from the ICU of a tertiary care hospital in India. Trop J Pharm Res. 2012;11(6):991–9.

Lautenbach E, Synnestvedt M, Weiner MG, Bilker WB, Vo L, Schein J, et al. Imipenem resistance in Pseudomonas aeruginosa: emergence, epidemiology, and impact on clinical and economic outcomes. Infect Control Hosp Epidemiol. 2010;31(1):47–53.

Lautenbach E, Polk RE. Resistant gram-negative bacilli: a neglected healthcare crisis? Am J Health Syst Pharm. 2007;64(23 suppl 14:):S3–21.

Dellit TH, Owens RC, McGowan JE,, Jr, Gerding DN, Weinstein RA, Burke JP, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159–77.

Sevanur SS, Gururay H. Study of antibiotic sensitivity and resistance pattern of bacterial isolates in intensive care unit setup of a tertiary care hospital. Indian J Crit Care Med. 2019; 23(12): 547–55.

Qadeer A, Akhtar A, Ain QU, Saadat S, Mansoor S, Assad S, et al. Antibiogram of medical intensive care unit at tertiary care hospital setting of Pakistan. Cureus. 2016;8(9):e809.

Tan R, Liu J, Li M, Huang J, Sun J, Qu H. Epidemiology and antimicrobial resistance among commonly encountered bacteria associated with infections and colonization in intensive care units in a university-affiliated hospital in Shanghai. J Microbiol Immunol Infect. 2014;47(2):87-94.

Ak O, Batirel A, Ozer S, Colakoglu S. Nosocomial infections and risk factors in the intensive care unit of a teaching and research hospital: a prospective cohort study. Med Sci Monit. 2011;17(5):PH29–34.




DOI: http://dx.doi.org/10.24125/sanamed.v15i3.451

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