Antibiograms of intensive care units at an Egyptian tertiary care hospital

Abstract

Background Intensive care unit (ICU) infection management is a growing challenge, and physicians should have regularly updated antibiograms. The aim of this study was to find out the prevalence of pathogens and to determine their antibiotic susceptibility in different ICUs of an Egyptian tertiary care hospital. This retrospective record-based cross-sectional study was conducted from the first of January to the last of December 2019 with a total of 45,221 diagnostic first-isolate culture/patient obtained from different ICUs in Zagazig University Hospitals. The antibiogram construction was done according to Clinical and Laboratory Standards Institute instructions and a Web-based antibiogram at Stanford University. Results The positive blood isolate was the most prevalent infection site (32.37%) followed by sputum and urine isolates. Gram-negative microorganisms (74.41%) were the most common pathogens, with Klebsiella pneumoniae as the most frequently identified one with an incidence of 33.51% followed by Escherichia coli with 19.3% incidence. Antibiotic sensitivity showed that colistin is the most effective antibiotic with 96.2%, 94.7%, and 89.9% sensitivity for Klebsiella, E. coli, and Acinetobacter, respectively, while carbepenems sensitivity was extremely low, showing 19.5% and 19% imipenem and meropenem sensitivity for Klebsiella, 48% imipenem and 52.7% meropenem sensitivity for E. coli, 20.1% imipenem and 20.3% meropenem sensitivity for Acinetobacter, and 17.3% imipenem and 15.2% meropenem sensitivity for Pseudomonas aeruginosa. Fungal infection in our results represented less than 1%. Conclusion Our study provides a local baseline epidemiological data which describes the extent of the ICU infections problem in this tertiary care hospital. Trial registration ClinicalTrials.gov (NCT04318613)

Carbapenem-Resistant Klebsiella pneumoniae Among Patients with Ventilator-Associated Pneumonia: Evaluation of Antibiotic Combinations and Susceptibility to New Antibiotics

“…More or less similar high rates were reported by other studies. 10 , 20–22 A high rate of carbapenem resistance was noticed where 71.2% of K. pneumoniae were carbapenem resistant, which is near to the results of a previous study in different ICUs in our facility. 20 The high rates of resistance are due to rapid horizontal transmission of resistance determinants between different species that is augmented by non-adherence to infection control standards.…”

“…In fact, the hospital authorities and staff did not stand idly by on the issue of antibiotic resistance and since 2016, a comprehensive infection control program was started comprising bundle care to reduce hospital-acquired and device-associated infections, and thus reduce antibiotics use. 27 Moreover, an antibiogram was developed in 2019 to rationalize antibiotic prescription, 20 but unfortunately, these endeavors were hampered by the emergence of COVID-19 global pandemic and shortage of medical staff. In addition, being a tertiary hospital, the majority of the patients most probably have received medical care at some primary centers before admission where they get colonized with resistant pathogens and consequently these pathogens are continuously introduced into the hospital environment.…”

Detection of carbapenemase production by blood culture carbapenem inactivation method (bcCIM) compared to modified carbapenem inactivation method (mCIM) in bloodstream infections

“…(77.8%) where higher than detected elsewhere. 11, 25 but in a more recent study conducted at ICUs of a tertiary care hospital in Egypt, similar high rates for carbapenem resistance were detected 28 . Bloodstream infections by carbapenemaseproducing GNB show variable rates in different world regions 13,[29][30][31] .…”

Antibiotics’ susceptibility patterns of bacterial isolates causing lower respiratory tract infections in ICU patients at referral hospitals in Namibia

“…In Egypt, they were K. pneumonia (33.5%), Staphylococcus spp. (23.2%) and E. coli (19.3%) (41); while in Uganda they were K. pneumonia, A. baumanii and P. aeruginosa among others (16,43). The differences may be associated with differences in the number of samples, which may be subject to study designs.…”

“…Six of the seven organisms associated with LRTI in ICUs in Namibia, P. aeruginosa, K. pneumoniae, E.coli, A. baumanii, Enterobacter sp. and S. aureus, have been associated with LRTIs in other countries (39)(40)(41)(42). However, there have been different frequencies.…”