Incidence of Hospital Acquired Multidrug Resistant Organisms in a Tertiary Care Facility

Abstract

Background: Irrational use of antimicrobials and gaps in infection control practices have resulted in alarmingly high prevalence of multidrug resistant organisms (MDRO) globally. The objective of our study was to highlight the incidence of hospital acquired MDROs in our facility. Method:A retrospective analysis of surveillance data collected from January -December 2013 in a tertiary care hospital of Saudi Arabia. The Centre for Disease Prevention and Control (CDC) surveillance definitions were used, while the MDRO definition was modified. Descriptive analysis was performed and incidence density was calculated. SPSS version 20 (IBM, Chicago, USA) was used for analysis. Result:In total 1737 MDRO isolates were identified. Of these n = 1,326 (76%) were hospital acquired and the mean incidence rate was 4.8 cases/1,000 patient-days. The most common risk factors were prolonged stay (≥ 5 days) n = 1134 (85.5%), indwelling medical devices 955 (72%) and antimicrobial therapy in past 90 days 949 (71.5%). Klebsiella pneumoniae n = 307(23%), Acinetobacter baumannii n = 270 (20%), Methicillin Resistant Staphylococcus aureus n = 183 (14%), Pseudomonas aeruginosa n = 160 (12%) and Escherichia coli n = 159 (12%) were the most prominent nosocomial pathogens. Resistance among gram negatives for cephalosporins ranged from 94% to 98%. A. baumannii (98%) and P. aeruginosa (89%) were resistant to carbapanems. More than 90% of A. baumannii were extensive drug resistant. Conclusion:The study indicated an alarmingly high incidence of hospital acquired MDRO in a single center. The increasing resistance warrants the need for a robust and continuous surveillance system for monitoring regional trends in MDRO susceptibility patterns and comprehensive infection control and antimicrobial stewardship programs.

Antimicrobial-Resistant Bacteria and Prescription of Antibiotics at a Tertiary Care Hospital in Riyadh, Saudi Arabia

“…On the other hand, the results of the study showed that there were 12 antimicrobial-resistant (AMR) bacteria in 2016 and 12 AMR bacteria in 2017 as well. The majority of these isolates were gram-negative bacteria, which is consistent with the findings of another study carried out at a tertiary care facility in Riyadh where the gram-negative organisms were found to be the most common (82.2%) [ 6 ]. In agreement with these results, it was reported that high rates of resistance to commonly used antibiotics were from gram-negative bacteria [ 7 ].…”

“…In a tertiary facility in Riyadh, it was found that “ A. baumannii isolates detected during the study period were almost resistant to all the drugs being tested. All the A. baumannii isolates would have been classified as XDR, i.e., resistant to three classes (all penicillin, cephalosporins, fluoroquinolones, and aminoglycosides) and carbapenems” [ 6 ].…”

Microbiological Profile of Significant Multi-Drug Resistant Organisms Isolated in a Tertiary Care Centre, Kerala, India

“…in this study. This is not an isolated phenomenon as evidenced in studies published from both high and low income countries (17,23,25,26) . Acinetobacter spp.…”

“…This could be because of increased selection pressure for microorganisms due to the use of multiple antibiotics in such a setting. Prevalence of MDRO's range from approximately 25% in studies from high income countries to 80% in that from low and middle income countries (11,17,18) .…”

“…were carbapenem resistant. This trend of increasing carbapenem resistance is evident from studies across the world and India (17,23,24) . One study from north India (24) reports that amongst enterobacteriaceae, higher percentage of carbapenem resistance was seen in klebsiella isolates when compared with E.coli (54% and 16%).…”