A 2-Year Single-Centre Audit on Antibiotic Resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae Strains from an Intensive Care Unit and Other Wards in a General Public Hospital in Greece

Abstract

Hospital-acquired infections, particularly in the critical care setting, are becoming increasingly common during the last decade, with Gram-negative bacterial infections presenting the highest incidence among them. Multi-drug-resistant (MDR) Gram-negative infections are associated with high morbidity and mortality, with significant direct and indirect costs resulting from long hospitalization due to antibiotic failure. As treatment options become limited, antimicrobial stewardship programs aim to optimize the appropriate use of currently available antimicrobial agents and decrease hospital costs. Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae are the most common resistant bacteria encountered in intensive care units (ICUs) and other wards. To establish preventive measures, it is important to know the prevalence of Gram-negative isolated bacteria and antibiotic resistance profiles in each ward separately, compared with ICUs. In our single centre study, we compared the resistance levels per antibiotic of P. aeruginosa, A. baumannii and K.pneumoniae clinical strains between the ICU and other facilities during a 2-year period in one of the largest public tertiary hospitals in Greece. The analysis revealed a statistically significant higher antibiotic resistance of the three bacteria in the ICU isolates compared with those from other wards. ICU strains of P. aeruginosa presented the highest resistance rates to gentamycin (57.97%) and cefepime (56.67%), followed by fluoroquinolones (55.11%) and carbapenems (55.02%), while a sensitivity rate of 97.41% was reported to colistin. A high resistance rate of over 80% of A. baumannii isolates to most classes of antibiotics was identified in both the ICU environment and regular wards, with the lowest resistance rates reported to colistin (53.37% in ICU versus an average value of 31.40% in the wards). Statistically significant higher levels of resistance to most antibiotics were noted in ICU isolates of K. pneumoniae compared with non-ICU isolates, with the highest difference—up to 48.86%—reported to carbapenems. The maximum overall antibiotic resistance in our ICU was reported for Acinetobacter spp. (93.00%), followed by Klebsiella spp. (72.30%) and Pseudomonas spp. (49.03%).

Distribution and Antimicrobial Susceptibility of Gram-Positive and Gram-Negative Pathogens Isolated from Patients Hospitalized in a Tertiary Teaching Hospital in Southwestern China

“…The results of the present study showed that the resistance levels to carbapenems, β-lactam-containing agents, and tigecycline in E. coli were higher than those in K. pneumoniae; however, E. coli and K. pneumoniae maintained high sensitivity to all the agents. In this study, the resistance rates of E. coli to all the antimicrobial agents in the whole hospital and the ICUs were higher than those reported in other areas, including by CHINET surveillance (5) and in Nanjing (26), Zhengzhou (6), and Greece (31). However, the resistance levels of K. pneumoniae to most of the antimicrobial agents were lower than those reported in these areas.…”

Impact of an Evidence-Based Antibiotic Protocol on Common Gram-Negative Bacteria's Antibiotic Resistance in a Cardiac Surgical Intensive Care Unit

“…Similarly, antibiotic stewardship decreased the incidence of carbapenem-resistant strains of K. pneumoniae, P. aeruginosa, and A. baumannii from 94 to 6%, 91 to 83%, and 38 to 2.5%, respectively. 8 Feretzakis et al 8 also demonstrated a reciprocal increase in the incidence of nonresistant isolates of above GNB, during the period, when resistant strains were decreasing. Strict surveillance should be followed for the emergence of new resistant pathogens while implementing a new antibiotic protocol.…”

“…In our study, the incidence of antibiotic resistance in these four gram-negative bacteria is similar to reported by Feretzakis et al for all antibiotics (Aminoglycosides, Fluoroquinolones, B lactam/ B lactamase combinations, and carbapenems) except Colistin. 8 Regarding resistance, in gram-negative bacteria, the antibiotics that have been at the center of research are Cephalosporins, carbapenems, and colistin. An earlier study published from our institute documented the incidence of various antibiotic-resistant bacteria in our CSICU (►Table 2).…”

Investigation of Acinetobacter baumannii Activity in Vascular Surgery Units through Epidemiological Management Based on the Analysis of Antimicrobial Resistance, Biofilm Formation and Genotyping

“…Pandrug resistant bacteria (PDR) and XDR isolates of A. baumannii have been reported for many years, not only in Polish hospitals, but also globally [9][10][11][12][13]. Infections caused by these strains are a serious therapeutic issue and are particularly common among intensive care unit (ICU) patients, but also appear in people hospitalized in other departments [14][15][16][17][18][19]. It seems that A. baumannii is one of the main etiologic agents of hospital associated infections (HAIs) and epidemic outbreaks in Poland, compared to infections caused by other non-fermenting bacteria (Pseudomonas aeruginosa), which are less frequently reported in our country [9,20,21].…”