Characteristics of Microbial Factors of Healthcare-Associated Infections Including Multidrug-Resistant Pathogens and Antibiotic Consumption at the University Intensive Care Unit in Poland in the Years 2011–2018

Abstract

Introduction: In recent years, an increase in healthcare-associated infections (HAIs) caused by resistant pathogens, which is a clinically troublesome trend, has been observed. The aim of the study was to analyze the microbial factors of HAIs and the drug resistance of microorganisms to selected antibiotics and their consumption. Material and Methods: The retrospective study included 3708 patients hospitalized in the intensive care unit (ICU) of the University Teaching Hospital in Wroclaw, who were diagnosed with 742 HAIs in the period from 1 January 2011 to 31 December 2018. The aim of the study was the analysis of microorganisms isolated in the respective clinical forms of HAIs, including the occurrence of “alert pathogens”, presence of multidrug-resistant (MDR) strains, and consumption of selected antibiotics. Findings: During the study period, 846 microorganisms were cultured in patients with HAIs, and among them, Acinetobacter baumannii MDR represented 31.8%; Klebsiella pneumoniae ESBLs, 11.3%; Pseudomonas aeruginosa MDR, 4.1% and MRSA, 2.2%; and Enterococcus spp. vancomycin-resistant enterococci (VRE), 1.3%. Among all the pathogens, Gram-negative bacteria (GNB) were dominant (71.6%). Gram-positive bacteria and fungi accounted for 21.6% and 7%, respectively. The total number of strains responsible for ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and central line-associated blood stream infection (CLA-BSI) was as follows: 458 (54.1%), 274 (32.4%), and 114 (13.5%), respectively. Among the etiological factors of VAP, there was a prevalence of A. baumannii MDR (41.9%), as well as in the case of UTI (21.9%). With regards to CLA-BSI, MRCNS (29.8%) was the dominant pathogen. The “alert pathogens” accounted for 54.7% of all the analyzed strains. The MDR strains represented 72.6% and 9.7% among A. baumannii and P. aeruginosa, respectively. In the years 2011 vs. 2018, an increase in infections with MDR bacilli was observed, 34.6% vs. 61.0% (p = 0.0008), respectively, including A. baumannii MDR 16.54% vs. 34.56 % (p = 0.0009) and Enterobacterales ESBL+/AMPC 11.8% vs. 15.44 % (p = 0.3921). Resistance to methicillin was confirmed in 35.2% of S. aureus strains. Resistance to vancomycin was found among 30.9% of Enterococcus spp. The observed period was marked by an increase in the consumption of carbapenems: 197.7 vs. 235.9 defined daily dose (DDD)/1000 patients-days. Conclusions: Gram-negative bacteria were found to be dominant pathogens in healthcare-associated infections. The most frequently cultured pathogens were multidrug-resistant A. baumannii, K. pneumoniae ESBL(+), and P. aeruginosa. The study showed an increase in the incidence of “alert pathogens” and MDR bacilli, as well as the tendency of a growing resistance to antibiotics during the observed period. Microbiological analysis of HAIs and the consumption of antibiotics is the necessary element of the proper antibiotic policy in hospitals.

Diversity of Oxacillinases and Sequence Types in Carbapenem-Resistant Acinetobacter baumannii from Austria

“…Carbapenem-resistant A. baumannii has emerged as a major culprit involved in nosocomial infections, especially in intensive care units [ 1 , 2 , 28 ].…”

“…The emergence of carbapenem resistance in Acinetobacter baumannii is a significant public health concern. Once A. baumannii was considered a low-category pathogen, and this organism now accounts for up to 20% of infections in ICUs [ 1 , 2 ], mainly associated with hospital acquired pneumonia and skin or soft tissue and bloodstream infections [ 3 ]. Along with Enterococcus faecium , Staphylococcus aureus , Klebsiella pneumoniae , Pseudomonas aeruginosa , and Enterobacter spp., A. baumannii is one of the ESKAPE pathogens of the WHO, which are on the priority list of antibiotic-resistant pathogens [ 4 ].…”

Escalating antimicrobial resistance among Enterobacteriaceae: focus on carbapenemases

“…Endemic and epidemic spread of CRE has been described in hospitals 15 , LTCF 17,18,106,107 and less commonly in community settings 2,30 . Not surprisingly, the incidence of infections with CRE is much higher in patients with co-morbidities 108 , immunodeficiency, neutropenia 109,110 , organ transplant recipients (OTR) 109,111,112 , diabetes mellitus 34,109,113 , recent hospitalization 104,105 , ICU stay 34 , hematological malignancy 109,110,114,115 , cardiac surgery 116 66,117 , rectal colonization 109,118 , receipt of broad spectrum antimicrobials 17,104,119 , invasive procedures 113 , peripheral or central venous catheters (CVC) 34,74,105,112,118,120 , indwelling urinary catheters 17 , and tracheostomy 113 . Rectal colonization with CRE is a risk factor for subsequent infection with CRE 113,118 .…”

Healthcare-Associated Laboratory-Confirmed Bloodstream Infections—Species Diversity and Resistance Mechanisms, a Four-Year Retrospective Laboratory-Based Study in the South of Poland

“…Among Gram-negative bacteria from ICUs, A. baumannii was the most resistant—its resistance to carbapenems was 70.6% vs. 79.8% in the ECDC data and 46.6% in the NHNS data and 78.8% in the study by Wałaszek et al Other Polish studies show resistance to carbapenems in A. baumannii at 72–87% [ 7 , 8 , 9 ]. Carbapenem-resistant P. aeruginosa was 66.7% vs. 33.4% in the ECDC data and 25.8% in the NHNS data, and K. pneumoniae with the ESBL mechanism was 72.4% while ECDC reports 53% of cephalosporin resistance and 89.7% of penicillin resistance.…”

“…In Poland, in particular in primary BSIs, CNS also dominates (depending on the study, from 20.8% to 44.2%), however, in secondary BSIs, there is still a large share of bacteria of the genus Acinetobacter (from 17.3% to 34.5%), although at present this trend has stopped somewhat. The abundant presence of Gram-negative species in BSIs, such as Acinetobacter baumannii or Klebsiella pneumoniae , is also associated with high antimicrobial resistance [ 6 , 7 , 8 , 9 ]. In BSIs, early active antibiotic therapy is associated with better outcomes.…”