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Incidence of multidrug-resistant bacteria in a general ICU: 1-year study
Critical Care volume 8, Article number: P218 (2004)
The aim of this study was to find the incidence of multidrug-resistant bacteria in a general ICU of the largest public hospital in Greece. Sporadic outbreaks of Gram-negative bacteria resistant to imipenem are being reported with increasing frequency worldwide, so it has become an emergency to improve the use of antimicrobial agents.
During the period November 2002–November 2003 (1 year) all patients of the ICU were retrospectively included in the study. Several factors, concerning the secondary infections, were noted: age, diagnosis at admission, APACHE score, time of hospitalization, origin of the positive culture of the microbe, resistance and outcome.
Among the 395 patients hospitalized at this period, 108 suffering from several diseases had positive cultures (27.34%). Fifty-eight of them have shown recovery (R group) (53.7%), whereas 50 patients have died (D group) (46.3%). Mean age was 57.04 years (53.66 years in the R group vs 60.96 years in the D group). Mean time of hospitalization was 16.5 days (15.73 days in the R group vs 17.48 days in the D group). Mean APACHE II score was 21.2 (20.68 in the R group vs 21.86 in the D group). Among 215 positive cultures, 56 were bronchial cultures, 84 blood cultures, 29 venaekatheter cultures, 19 ascites fluid cultures, three cerebrospinal fluid cultures and four wound cultures. Eleven patients had positive venaekatheter culture and blood culture at the same time. Referring to the 108 patients, there was in 62.96% Acinetobacter baumannii, in 24.07% Pseudomonas aeruginosa, in 20.37% Klebsiella pneumoniae, in 8.33% Enterococcus Faecalis, in 5.56% Staphylococcus aureus, and in 4.63% Candida albicans isolated. A. baumannii was multiresistant (MULTI-R) against antibiotics in 17.65% of patients (or in 11.65% of cultures), or with intermediate sensitivity only in Gentamycin (GENT-I) in 8.82% of patients (7.77% of cultures). Generally, 25% of patients had MULTI-R or GENT-I A. baumannii (19.42% of cultures). In the D group, 36.36% had MULTI-R or GENT-I A. baumannii (23.73% of cultures): 24.24% MULTI-R (13.56% of cultures), 15.15% GENT-I (10.17% of cultures). Oppositely, in the R group, only 14.29% had MULTI-R or GENT-I A. baumannii (13.64% of cultures): 11.43% MULTI-R (9.09% of cultures), 2.86% GENT-I (4.55% of cultures). P. aeruginosa was MULTI-R in 42.31% of patients (44.12% of cultures): in 54.55% of the D group (55.56% of cultures) vs 33.33% of the R group patients (31.25% of cultures). K. pneumoniae was sensitive only in imipenem or cotrimoxazole in 7.69% of the R group and only in kinolones in 11.11% of the D group patients.
No vancomycin-resistant Enterococci, methicillin-resistant S. aureus or vancomycin-resistant S. aureus were isolated in our unit and that is encouraging. Nevertheless, an important percentage of multidrug-resistant A. baumanii, P. aeruginosa and K. pneumoniae was identified in long-term ICU patients, which probably was the reason for their poor outcome. Measures are certainly needed to prevent or delay the appearance of resistant strains.
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Kydona, C., Malamis, G., Sidiropoulou, N. et al. Incidence of multidrug-resistant bacteria in a general ICU: 1-year study. Crit Care 8, P218 (2004). https://doi.org/10.1186/cc2685
- Candida Albicans
- Klebsiella Pneumoniae
- Positive Culture
- Enterococcus Faecalis