Bacterial resistance in the intensive care unit of developing countries: Report from a tertiary hospital in Kazakhstan

Viderman, Dmitriy; Brotfain, Evgeni; Khamzina, Yekaterina; Kapanova, Gulnara; Zhumadilov, Agzam; Poddighe, Dimitri

doi:10.1016/j.jgar.2018.11.010

Cited by 22 publications

(12 citation statements)

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“…For S. aureus, the resistance rate to most of the antimicrobial agents in the whole hospital was lower than that reported by CHINET surveillance (5) and those in Zhengzhou (6), Nanjing (26), and North Korea (27), but higher than that reported in Dongguan (33). In the ICUs, the resistance rates of S. aureus to most of the antimicrobial agents were lower in our study than those in Greece (21) and higher than those in Kazakhstan (32). The difference in resistance of these bacteria to different antibiotics may be related to the distribution of patients in the region and the management of antibiotic use.…”

Section: Discussioncontrasting

confidence: 74%

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

Zeng

Ding

et al. 2021

Jundishapur J Microbiol

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Background: Bacteria are the most common causes of clinical infectious diseases. The distribution and antimicrobial resistance (AMR) rates of bacteria provide important guidelines for clinical antibacterial treatment; however, the information in this region is still missing. Objectives: This study aimed to evaluate the changes in the distribution and AMR rates of clinical isolates from inpatients. Methods: We conducted a retrospective cross-sectional analysis of the distribution and antimicrobial susceptibility of all non-duplicate gram-negative bacterial (GNB) and gram-positive bacterial (GPB) isolates collected from January 1, 2013, to December 31, 2018, in our hospital. Results: In total, 56,535 and 3,518 non-repetitive isolates were detected in the whole hospital and intensive care units (ICUs), respectively. The isolates included GPB (26.3% and 18.4%, respectively) and GNB (73.7% and 81.6%, respectively). The five dominant bacteria were the same in the whole hospital and ICUs, but Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii percentages were different. The detection rates of all isolates and five dominant bacteria were significantly different between the ICUs and the whole hospital (P < 0.05). The detection rate of extended-spectrum β-lactamase (ESBL)-E. coli (54.1%) was significantly higher than that of K. pneumoniae (26.1%). The detection rates of carbapenem-resistant (CR) and extensively drug-resistant (XDR)-A. baumannii were the highest in both the ICUs (87.1% and 21.8%, respectively) and the whole hospital (65.5% and 12.9%, respectively). The methicillin-resistant S. aureus (MRSA) detection rate was high (26.5%) but showed a significant decreasing trend (P < 0.05). The detection rates of ESBL and XDR-E. coli, CRAB, and XDR-S. aureus were significantly different between the ICUs and the whole hospital (P < 0.05). Gram-negative bacteria were highly susceptible to amikacin (> 90%) and tigecycline (> 98%). S. aureus showed 100% susceptibility to vancomycin and linezolid. A. baumannii had the highest resistance to imipenem (62.8%) and meropenem (64.0%). Except for A. baumannii and E. coli (P < 0.05), the AMR levels and the trends of the other isolates were similar between the ICUs and the whole hospital (P > 0.05). Conclusions: Currently, the appropriate antimicrobial agents in our hospital include amikacin and tigecycline for the treatment of GNB infections and vancomycin and linezolid for the treatment of GPB infections. Moreover, it is still necessary to monitor AMR in the ICUs and the whole hospital simultaneously.

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Section: Discussioncontrasting

confidence: 74%

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

Zeng

Ding

et al. 2021

Jundishapur J Microbiol

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“…34 A study from a small single-center ICU in Kazakhstan showed that 55% of E. coli and 25% of K. pneumoniae isolates were resistant to cefepime but no significant resistance was noted against amikacin and carbapenems. 35 A single-center ICU study from Vietnam indicates that 90.5% of Acinetobacter, 86.2% of P. aeruginosa, and 20.0% of Klebsiella respiratory isolates are resistant to meropenem. 36 In an ICU in India the overall rate of MDR-gram negatives is 55.7% with the highest rate being Acinetobacter spp at 82.1%.…”

Section: Epidemiology Of Gram-negative Resistance In Intensive Care Umentioning

confidence: 99%

Difficult-to-Treat Antibiotic-Resistant Gram-Negative Pathogens in the Intensive Care Unit: Epidemiology, Outcomes, and Treatment

Strich

Kadri

2019

Semin Respir Crit Care Med

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Antibiotic resistance among gram-negative pathogens is a world-wide problem that poses a constant threat to patients in the intensive care unit and a therapeutic challenge for the intensivist. Furthermore, the substantial economic burden and increased mortality associated with infections due to highly resistant gram-negative pathogens exacerbate these challenges. Understanding the mechanisms, epidemiology, and risk factors for these infections is paramount to the successful control of outbreaks and for guiding therapy which often entails use of antibiotics with suboptimal efficacy and/or toxicity profiles. In this review we will discuss the global epidemiology, burden, risk factors, and treatment of highly resistant gram-negative infections as they apply to the intensive care population.

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“…A high burden of infectious diseases, such as respiratory and genitourinary infections, tuberculosis and sexually transmitted diseases, high usage of over-the-counter antibiotics, and widely prevalent antibiotic use based on self-diagnosis are among the contributing factors 12,13 . Multidrugresistant GPOs are a growing concern in other Central Asian countries 14 .…”

Section: Profile Of Clinical Gram Positivementioning

confidence: 99%

Microbiological and Susceptibility Profile of Clinical Gram Positive Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia

Felsenstein

Bira

Altanmircheg

et al. 2019

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Introduction: Information on microbiological and susceptibility profiles of Monoglian bacterial isolates is scarce. Resistance profiles, patient demographics and microbiological work-up of gram positive isolates were analyzed in order to develop infection control activities and policies at the National Center for Maternity and Children’s Health (NCMCH) in Ulaanbataar, Mongolia.Methods: All gram positive isolates of specimens submitted to the microbiology laboratory at NCMCH between January 2014 and August 2017 were included. Data collected included demographic data, specimen type, in-/outpatient status, hospital ward of sample origin, and antimicrobial susceptibility testing profile. Susceptibility testing was performed by trained microbiologists at the NCMCH microbiology laboratory. T-test, Mann-Whitney, Chi-square and Fisher exact tests were used as appropriate.Results: Of 11,889 isolates, 4012 (33.7%) were gram positive, with most identified as S. aureus (62.6%, n=2512). Rates of methicillin resistance (MRSA) remained stable at a quarter, but was significantly higher among inpatients (inpatients: 630/2002, 31.5%; outpatients 67/290, 23.1%; p≤0.05) and sterile site isolates (sterile: 83/171, 48.5%; non-sterile: 416/1678, 24.8%; p≤0.01). The vast majority of S. pneumoniae isolates (12/14; 85%) was found to be penicillin resistant by oxacillin disk diffusion. While identification of Group B streptococci was rare (n=137) due to of lack of diagnostic measures available, the number of enterococcal isolates identified increased signifi-cantly due to implementation of improved microbiological work-up (2015: n=7; 2016: n=26; 2017: n=83).Conclusion: Compared with published studies from neighboring nations, the rates of antimicrobial resistance among gram positive isolates at NCMCH, particularly with respect to S. aureus and S. pneumoniae, were much higher. Further improvement of microbiological diagnostics and collabo-ration of stakeholders is required to address the pressing infection control and stewardship issues and to ensure reliable identification of relevant pathogens in Mongolia.

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Bacterial resistance in the intensive care unit of developing countries: Report from a tertiary hospital in Kazakhstan

Cited by 22 publications

References 9 publications

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

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

Difficult-to-Treat Antibiotic-Resistant Gram-Negative Pathogens in the Intensive Care Unit: Epidemiology, Outcomes, and Treatment

Microbiological and Susceptibility Profile of Clinical Gram Positive Isolates at a Tertiary Pediatric and Maternity Hospital in Ulaanbaatar, Mongolia

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