Multidrug-Resistant and Extensively Drug-Resistant Enterobacteriaceae: Prevalence, Treatments, and Outcomes – A Retrospective Cohort Study

Abstract

Background Drug-resistant gram-negative bacteria (GNB) are a global public health threat, especially in intensive care units (ICU). This study explored the prevalence of drug-resistant Enterobacteriaceae infections in an ICU in Saudi Arabia. The appropriateness of the antibiotic therapies used and their ability to improve the clinical outcomes were also assessed. Methods A retrospective study was conducted from 2015 to 2018 in the different ICUs of a tertiary-care hospital in Saudi Arabia. Positive cultures for multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) Enterobacteriaceae, including Klebsiella pneumoniae, Escherichia coli , and Enterobacter sp., were included. The primary outcomes involved microbiological cure and 30 days in-hospital mortality rate, while the secondary outcome included the length of hospital stay (LOS). Regression models were used to assess the relationship between appropriateness of the antibiotic therapy and clinical outcomes. Results Of the 227 Enterobacteriaceae cultures included in this study, 60% were either MDR (n= 130) or XDR (n= 8) infections; no PDR Enterobacteriaceae cultures were identified. Majority of the patients were female (54%), and the average age was 60.1 ± 17.7 years. MDR/XDR cultures primarily comprised E. coli (51.4%), followed by K. pneumoniae (33%) and Enterobacter sp. (16%). Most commonly used antibiotics were piperacillin/tazobactam (53%), carbapenems (47%), and cephalosporins (21.3%). Antibiotic therapy was considered appropriate in only 85 of 138 (61.59%) patients. Microbiological cure rate was achieved in 40% of the cases, and in-hospital death rate was 84%. The average LOS was 27 days. Appropriateness of the antibiotic therapy prescribed could not predict any of the study outcomes. Conclusion The study revealed a high prevalence of drug-resistant Enterobacteriaceae infections, which were associated with a high mortality rate. Therefore, it is essential to assess the effectiveness of antimicrobial stewardship program and infection prevention and control practices, particularly in critically ill patients.

Silver and Gold Nanoparticles for Antimicrobial Purposes against Multi-Drug Resistance Bacteria

“…PDR was determined as non-susceptibility to all agents in all antimicrobial types. MDR was determined as attained non-susceptibility to at least one agent in three or more antimicrobial types [ 20 , 21 ]. To overcome the problem of resistance, it will be essential to alter the protocols of applying antimicrobials so that these drugs are administered when all other treatment routes have failed.…”

What Doesn’t Kill Them Makes Them Stronger: The Impact of the Resistance Patterns of Urinary Enterobacterales Isolates in Patients from a Tertiary Hospital in Eastern Europe

“…Of those, the majority was MDR (35.5%), followed by XDR (4.8%) and PDR (3.1%). The identification of PDR strains represents a major concern; multiple studies that analyzed the resistance profile of Gram-negative pathogens have failed to identify such a pattern [13,22], while others have reported negligible amounts [23,24].…”

“…The latest CDC report provided definitions for two other antimicrobial resistance patterns [11]: The impact of multidrug-resistant Gram-negative bacteria (MDR-GNB) infections can be determined by assessing the clinical outcomes, such as length of stay in the hospital or mortality rates. Although most of the studies found significant correlations between MDR-GNB and mortality risk, other authors failed to demonstrate such an association, therefore the topic remains controversial a fertile ground for further research [12][13][14][15]. This research is a sequel of our previous observations, which focused on the characterization of UTIs caused by K. pneumoniae, motivated by the necessity of determining the resistance patterns for all Enterobacterales against common antibiotic classes in treating UTIs.…”

ESBL Activity, MDR, and Carbapenem Resistance among Predominant Enterobacterales Isolated in 2019

“…These reports are in accordance with our results on the most common bacterial isolation and ESBL activity, with a slight variation in MDR prevalence among the two bacteria. A study from Addis Ababa reported a 42.1% MDR among Enterobacteriaceae [ 30 ]; however, another recent study from Saudi Arabia reported an overall prevalence of 60% MDR Enterobacteriaceae , with E. coli and K. pneumoniae as the most frequent isolates [ 31 ], but this prevalence was only 6.6% in the USA hospitals [ 32 ]. The analysis adopted in the present study revealed higher MDR prevalence, and this prevalence was determined for the three predominant bacteria and not for all Enterobacterales isolates reported during the study period.…”