Multidrug-Resistant Organisms and Their Association with Risk Factors; A Study at the Intensive Care Unit of Tertiary Care Hospital, Peshawar
DOI:
https://doi.org/10.51253/pafmj.v73i6.10323Keywords:
Multidrug-resistant organisms (MDRO), Antimicrobial resistance (AMR), Intensive care unitAbstract
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.
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