BackgroundThe Centers for Disease Control and Prevention (CDC) proposed standard definitions for acquired resistance in bacterias. Resistant bacteria were categorized as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR). This study describes the incidence of Gram-negative MDR, XDR and PDR in 12 private and adult intensive care units (ICU’s) from Belo Horizonte, Minas Gerais, the sixth most populated city in Brazil, with approximately 3 million inhabitants.MethodsData were collected between January/2013 to December/2017 from 12 ICU’s. The hospitals used prospective healthcare-associated infections (HAI) surveillance protocols, in accordance to the CDC. Antimicrobial resistance from six Gram-negatives, causing nosocomial infections, were evaluated: Acinetobacter sp., Klebsiella sp., Proteus sp., Enterobacter sp., Escherichia coli, and Pseudomonas sp.. We computed the three categories of drug-resistance (MDR+XDR+PDR) to define benchmarks for the resistance rate of each Gram-negative evaluated. Benchmarks were defined as the superior limits of 95% confidence interval for the resistance rate.ResultsAfter a 5 year surveillance, 6,242 HAI strains were tested: no pandrug-resistant bacteria (PDR) was found. Acinetobacter sp. was the most resistant Gram-negative: 206 strains from 1,858 were XDR (11%), and 1,638 were MDR (88%). Pseudomonas sp.: 41/1,159 = 3.53% XDR; 180/1,159 = 15.53% MDR. Klebsiella sp.: 2/1,566 = 0,1% XDR; 813/1,566 = 52% MDR. Proteus sp.: 0/507 = 0% XDR; 163/507 = 32% MDR. Enterobacter sp.: 0/471 = 0% XDR; 148/471 = 31% MDR. Escherichia coli: 0/681 = 0% XDR; 157/681 = 23% MDR. Benchmarks for the global resistance rate of each Gram-negative (MDR+XDR+PDR): Acinetobacter sp. = 92%; Klebsiella sp. = 62%; Proteus sp. = 40%; Enterobacter sp. = 48%; Escherichia coli = 33%; Pseudomonas sp. = 30%.ConclusionThis study has calculated the incidence of Gram-negative MDR, XDR and PDR, and found a higher incidence of MDR Acinetobacter sp., with an 88% multiresistance rate. Henceforth, developing countries healthcare institutions must be aware of an increased risk of infection by Acinetobacter sp.. Benchmarks have been defined, and can be used as indicators for healthcare assessment. Disclosures All authors: No reported disclosures.

BackgroundApplying benchmarks from high resource countries on low resource countries may result in misleading conclusions, thus improvements can be made in order to refine the precision of external benchmarks in developing countries.MethodsThe NOIS Project uses SACIH software to retrieve data from different hospitals at Belo Horizonte, Brazil. The hospitals use prospective Healthcare-Associated Infections—HAI surveillance according to the NHSN/CDC protocols. The objective is to calculate benchmarks for HAI rates from intensive care units, ICU, and surgical procedures. Benchmarks were defined as the 10 percentile and 90 percentile, considering data from 11 hospitals and 13 ICUs, collected between 2013 and 2017.ResultsHospital-wide and ICUs benchmarks: HAI risk [1.5%; 4.7%]; HAI incidence per 1,000 patient-days [4.4; 12.6]; ICU infection risk [4.0%; 23.8%]; ICU incidence density rate of HAI per 1,000 patient-days [10.8; 35.7]; risk of urinary catheter-associated urinary tract infections[0.0%; 6.3%]; incidence density rate of urinary catheter-associated urinary tract infections per 1,000 urinary catheter-days [0.0; 9.4]; risk of central line-associated primary bloodstream infections [0.0%; 10.3%]; incidence density rate of central line-associated primary bloodstream infections per 1,000 central line-days [0; 16]; risk of ventilator associated pneumonia [0.0%; 13.5%]; incidence density rate of ventilator associated pneumonia per 1,000 ventilator-days [0.0; 20.6]. Surgical site infection benchmarks: Cesarean section [0,6%;0,9%]; open reduction of fracture [3,3%;3,9%]; Gallbladder surgery [0,7%;1%]; herniorrhaphy [1,1%;1,6%]; peripheral vascular bypass surgery [0,6%;1%]; gastric surgery [1,7%;2,4%]; appendix surgery [1,1%;1,8%]; colon surgery [3,0%;4,1%]; exploratory abdominal surgery [4,1%;5,3%]; craniotomy [5%;6,5%]; abdominal hysterectomy [0,7%;1,4%]; limb amputation [4,1%;6,1%]; thoracic surgery [0,8%;1,5%]; hip prosthesis [3%;4,3%]; knee prosthesis [2,3%;3,5%]; pacemaker surgery [1,9%;3,1,0%]; breast surgery [0,3%;0,9%]; bile duct, liver or pancreatic surgery [7%;11%]; ventricular shunt [3,3%;6,5%].ConclusionThe benchmarks proposed can be used by infection preventionists that decide to monitor selected surgical procedures and/or ICUs, especially in developing countries.Disclosures All authors: No reported disclosures.