Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors

Abstract

BACKGROUND Intensive care unit (ICU) patients are critically ill and have low immunity. They will undergo various trauma medical procedures during diagnosis and treatment. The use of high-dose hormones and broad-spectrum antibiotics will increase the incidence of nosocomial infection in ICU patients. Therefore, it is necessary to explore the causes of nosocomial infection in ICU and provide basis for the prevention and control of nosocomial infection in ICU. AIM To explore major pathogens of nosocomial infection in ICUs, methods of detection and drug resistance trends. METHODS Risk factors of multidrug-resistant infection were analyzed to provide a basis for clinical rational use of antimicrobial drugs in the ICU. These findings were used to standardize rational use of antimicrobial agents. BD PhoenixTM100 automatic bacterial identification analyzer was used to for cell identification in specimens collected from the ICU between January 2016 and December 2019. Drug sensitivity tests were carried out and drug resistance trends were analyzed using the optical disc diffusion method. Odds ratios and corresponding 95%CI of independent variables were calculated using a logistic regression model. Backward elimination (trend = 0.1) was used as an inclusion criterion for multivariate analysis. All data were analyzed using SPSS version 22.0, and P < 0.05 was considered statistically significant. RESULTS We collected 2070 samples from ICU patients between January 2016 and December 2019. Sample types comprised sputum (1139 strains, 55.02%), blood (521 strains, 25.17%), and drainage fluid (117 strains, 5.65%). A total of 1051 strains of major pathogens, including Acinetobacter baumannii , Escherichia coli ( E. coli ), Pseudomonas aeruginosa ( P. aeruginosa ), Klebsiella pneumoniae ( K. pneumoniae ) and Staphylococcus aureus , were detected, with a detection rate of 35.97% (378/1051). Most of these strains were resistant to antibiotics. Detection rate of E. coli was 21.79% (229/1051), and it was generally sensitive to many antimicrobial drugs. Detection rate of P. aeruginosa was 24.74% (260/1051), and showed low sensitivity to most antibiotics. Detection rate of K. pneumoniae was 9.42% (99/1051), which was generally resistant to multiple antimicrobial drugs and resistant forms. K. pneumoniae was resistant to imipenem for approximate 4 years, and showed a 19.9% (19/99) and 20.20% (20/99) rate of meropenem resistance. Logistic analysis showed that mechanical ventilation and ureteral intubation were risk factors for multidrug-resistant bacterial infections. CONCLUSION ...

Characterization of β-Lactamase Genes among Multidrug- and Extensively Drug-Resistant Acinetobacter and Enterobacteriaceae Species Causing Infections in Critically Ill Patient

“…The predominant species, isolated during the present study, were A. baumannii (18 isolates, 42.9%) followed by K. pneumoniae (16 isolates, 38.1%), E. coli (6 isolates, 14.3%) and P. stuartii (2 isolates, 4.7%). Similar results were demonstrated by Han et al 19 15 who reported that A. baumannii was resistant to carbapenems, aminoglycosides, most cephalosporins and sulfa containing antibiotics with resistance rates of > 75%. They also reported A. baumannii polymyxin sensitivity of 96.67%.…”

Is every microorganism detected in the intensive care unit a nosocomial infection? Isn’t prevention more important than detection?

“…The reason for this is the widespread use of antibiotics in the community before admission to the hospital in our country. The discussion of Han et al [ 1 ] of this high carbapenem and polymxin resistance in their study will add strength to their study.…”

“…We recently read with great interest the manuscript by Han et al [ 1 ] entitled “Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors,’’ which was published in the last issue of World J Clin Cases . We would like to state that the article is very detailed, and we have benefited from it in many points.…”

“…It is recommended to use infection prevention packages for the prevention of nosocomial ventilator-associated pneumonia, blood-catheter infection, urinary tract infection, and other infections in the ICU and to check compliance with these packages, particularly by the infection control committee[ 3 , 4 ]. In the study of Han et al [ 1 ], although one of the authors was affiliated with an infection control committee, the control precautionary packages and the rates of compliance with the precautionary packages in the ICU were not mentioned in the study. If one of the aims of the study was to examine the risk factors for the development of nosocomial infection in the ICU, the rates of compliance with these infection prevention packages should be included in the study.…”

“…In the study of Han et al [ 1 ] where the rate of intubated patients was 98.1%, resistance rates of A. baumannii to minocycline in 2017 and 2019 were found as 28.41% and 32.42%, respectively; whereas meropenem resistance was 74.6%, and the imipenem resistance rate was 75.66%. Carbapenem resistance of A. baumannii has increased from 2005 to 2018 all over the world, which is an important issue.…”