Multidrug-Resistant Organisms and Their Association with Risk Factors; A Study at the Intensive Care Unit of Tertiary Care Hospital, Peshawar

Authors

  • Mariam Sarwar Combined Military Hospital/National University of Medical Sciences (NUMS) Peshawar Pakistan
  • Fuad Ahmad Siddiqi Combined Military Hospital/National University of Medical Sciences (NUMS) Peshawar Pakistan
  • Salman Riaz RHQ Hospital, Gilgit Pakistan
  • Ammad Hasan Chaudhry Combined Military Hospital/National University of Medical Sciences (NUMS) Peshawar Pakistan
  • Muhammad Hassan Banazir Bhutto Hospital, Rawalpindi Pakistan
  • Ashfaq Hussain Combined Military Hospital/National University of Medical Sciences (NUMS) Mardan Pakistan

DOI:

https://doi.org/10.51253/pafmj.v73i6.10323

Keywords:

Multidrug-resistant organisms (MDRO), Antimicrobial resistance (AMR), Intensive care unit

Abstract

Objective: To investigate rates of multidrug-resistant organisms (MDRO) infection, their antimicrobial resistance (AMR)
patterns, and risk factors for acquisition of such infections at a Tertiary-Care Hospital ICU.

Study Design: Cross sectional study.

Place and Duration of Study: Adult Intensive Care Unit of Tertiary Care Hospital, Peshawar Pakistan, from Jan to Dec 2022.

Methodology: All patients admitted to adult ICU who developed signs/symptoms of infection after 48 hours of admission
were investigated. Microbiological diagnosis was done via standard microbiological practices, and if the patient had acquired an MDRO infection, it was included in the study.

Results: During the study, 92 patients acquired MDRO infection in total. The most common source was blood (43.5%). The
most common organisms isolated were Klebsiella pneumoniae (21.7%), Acinetobacter baumannii (20.7%) and Pseudomonas
aeruginosa (17.4%). The highest percentage of resistance among Gram-positive organisms was exhibited to Penicillin and
Co-amoxiclav (91%). Gram-negative isolates exhibited high overall resistance to all used antibiotic classes. The least frequency of resistance was recorded for Tigecycline (1%) against Klebsiella pneumoniae and 33% against Escherichia coli, while 32% Acinetobacter baumannii and 25% Pseudomonas aeruginosa were Colistin/Polymyxin resistant; none of the Klebsiella pneumoniae showed Colistin resistance.

Conclusion: Antimicrobial resistance in our setup was high among Gram-negative and Gram-positive organisms. The most
common risk factor was central line placement among the patients, highlighting the importance of infection control measures and the need to implement infection control bundles to circumvent infections due to invasive devices.

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References

CDC. Antimicrobial Resistance.[Internet]. Available at:

https://www.cdc.gov/drugresistance/about.html. (Accesses on

October 5, 2022).

Qu J, Huang Y, Lv X. Crisis of antimicrobial resistance in

China: now and the future. Front Microbiol 2019; 10: 2240.

https://doi.org/10.3389%2Ffmicb.2019.02240

Moo CL, Yang SK, Yusoff K, Abushelaibi A, et al. Mechanisms of

antimicrobial resistance (AMR) and alternative approaches to

overcome AMR. Curr Drug Discov Technol 2020; 17(4): 430-447.

https://doi.org/10.2174/1570163816666190304122219

Zanichelli A, Sgobba SP, Merlo A. Health-care associated

infections surveillance in elderly patients. Eur J Intern Med 2022;

: 149-150. https://doi.org/10.1016/j.ejim.2022.03.004

Cantón R. Antimicrobial resistance in ICUs: an update in the

light of the COVID-19 pandemic. Curr Opin Crit Care

; 26(5): 433-441.

https://doi.org/10.1097/mcc.0000000000000755

Soundaram GV, Sundaramurthy R, Jeyashree K, Ganesan V,

Arunagiri R. Impact of care bundle implementation on incidence

of catheter-associated urinary tract infection: a comparative

study in the intensive care units of a tertiary care teaching

hospital in South India. Indian J Crit Care Med 2020; 24(7): 544.

https://doi.org/10.5005/jp-journals-10071-23473

Wang L, Zhou KH, Chen W, Yu Y, Feng SF. Epidemiology

and risk factors for nosocomial infection in the respiratory

intensive care unit of a teaching hospital in China: A prospective

surveillance during 2013 and 2015. BMC Infect Dis 2019; 19(1):

https://doi.org/10.1186%2Fs12879-019-3772-2

Magira EE, Islam S, Niederman MS. Multi-drug resistant

organism infections in a medical ICU: Association to clinical

features and impact upon outcome. Med Intensiva (English

Edition) 2018; 42(4): 225-34.

https://doi.org/10.1016/j.medin.2017.07.006

Morris S, Cerceo E. Trends, epidemiology, and management of

multi-drug resistant gramnegative bacterial infections in the

hospitalized setting. Antibiotics 2020; 9(4): 196.

https://doi.org/10.3390/antibiotics9040196

CLSI. Performance Standards for Antimicrobial Susceptibility

Testing. 32th ed. CLSI supplement M100. Wayne, PA: Clinical

and Laboratory Standards Institute; 2022.

Han Y, Zhang J, Zhang HZ, Zhang XY, Wang YM. Multidrugresistant organisms in intensive care units and logistic analysis

of risk factors. World J Clin Cases 2022; 10(6): 1795.

https://doi.org/10.12998/wjcc.v10.i6.1795

Luyt CE, Bréchot N, Trouillet JL, Chastre J. Antibiotic

stewardship in the intensive care unit. Crit Care 2014; 18(5): 480.

https://doi.org/10.1186/s13054-014-0480-6

Despotovic A, Milosevic B, Milosevic I, Mitrovic N, Cirkovic A,

Jovanovic S, et al. Hospitalacquired infections in the adult

intensive care unit - Epidemiology, antimicrobial resistance

patterns, and risk factors for acquisition and mortality. Am J

Infect Control 2020; 48(10): 1211-1215.

https://doi.org/10.1016/j.ajic.2020.01.009

Ben-David D, Vaturi A, Solter E, Temkin E, Carmeli Y, Schwaber

MJ, et al. Israel CLABSI Prevention Working Group. The

association between implementation of second-tier prevention

practices and CLABSI incidence: A national survey. Infect

Control Hosp Epidemiol 2019; 40(10): 1094-1099.

https://doi.org/10.1017/ice.2019.190

Shaikh JM, Devrajani BR, Shah SZ, Akhund T, Bibi I. Frequency,

pattern and etiology of nosocomial infection in intensive care

unit: an experience at a tertiary care hospital. J Ayub Med Coll

Abbottabad 2008 ; 20(4): 37-40.

Halim MM, Eyada IK, Tongun RM. Prevalence of multidrug

drug resistant organisms and hand hygiene compliance in

surgical NICU in Cairo University Specialized Pediatric

Hospital. Egypt Paediatr Assoc Gaz 2018; 66(4): 103-111

http://dx.doi.org/10.1016/j.epag.2018.09.003

Tayyab N, Furqan W, Nasrullah A, Usman J, Ali S, Khan AZ, et

al. MDR bacterial infections in critically ill Covid-19 patients in a

tertiary care hospital (of Pakistan). Pak Armed Forces Med J

; 71(3): 1027-1032.

https://doi.org/10.51253/pafmj.v71i3.5478

Fahim NA. Prevalence and antimicrobial susceptibility profile of

multidrug-resistant bacteria among intensive care units patients

at Ain Shams University Hospitals in Egypt - a retrospective

study. J Egypt Public Health Assoc 2021; 96(1): 1-0.

https://doi.org/10.1186/s42506-020-00065-8

Ledger EV, Sabnis A, Edwards AM. Polymyxin and lipopeptide

antibiotics: membrane-targeting drugs of last resort.

Microbiology (Reading) 2022; 168(2): 001136.

https://doi.org/10.1099/mic.0.001136

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Published

30-12-2023

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Original Articles

How to Cite

1.
Sarwar M, Fuad Ahmad Siddiqi, Salman Riaz, Ammad Hasan Chaudhry, Muhammad Hassan, Ashfaq Hussain. Multidrug-Resistant Organisms and Their Association with Risk Factors; A Study at the Intensive Care Unit of Tertiary Care Hospital, Peshawar. Pak Armed Forces Med J [Internet]. 2023 Dec. 30 [cited 2024 Jun. 14];73(6):1769-72. Available from: https://pafmj.org/PAFMJ/article/view/10323