Collective assessment of antimicrobial susceptibility among the most common Gram-negative respiratory pathogens driving therapy in the ICU (original) (raw)
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Journal of global antimicrobial resistance, 2018
This study assessed trends and patterns in antimicrobial resistant intensive care unit (ICU)-acquired infections caused by Gram-negative bacteria (GNB) in Istanbul, Turkey. Bacterial culture and antibiotic susceptibility data were collected for all GNB causing nosocomial infections in five adult ICUs of a large university hospital during 2012-2015. Multi-resistance patterns were categorised as multidrug (MDR), extensively-drug (XDR) and pandrug (PDR)-resistance. Patterns and trends were assessed using seasonal decomposition and regression analyses. Of 991 pathogenic GNB recorded, most frequent were Acinetobacter baumannii (35%), Klebsiella species (27%), Pseudomonas aeruginosa (18%), Escherichia coli (7%) and Enterobacter species (4%). The overall infection rate decreased by 41% from 18.4 to 10.9 cases per 1000 patient-days in 2012 compared to 2015 (p <0.001), mostly representing decreases in bloodstream infections and pneumonias by A. baumannii and P. aeruginosa. XDR proportion ...
Diagnostic Microbiology and Infectious Disease, 2014
The Study for Monitoring Antimicrobial Resistance Trends program monitors the activity of antibiotics against aerobic and facultative Gram-negative bacilli (GNBs) from intra-abdominal infections (IAIs) in patients worldwide. Methods In 2011, 1 929 aerobic and facultative GNBs from 21 hospitals in 16 cities in China were collected. All isolates were tested using a panel of 12 antimicrobial agents, and susceptibility was determined following the Clinical Laboratory Standards Institute guidelines. Results Among the Gram-negative pathogens causing IAIs, Escherichia coli (47.3%) was the most commonly isolated, followed by Klebsiella pneumoniae (17.2%), Pseudomonas aeruginosa (10.1%), and Acinetobacter baumannii (8.3%). Enterobacteriaceae comprised 78.8% (1521/1929) of the total isolates. Among the antimicrobial agents tested, ertapenem and imipenem were the most active agents against Enterobacteriaceae, with susceptibility rates of 95.1% and 94.4%, followed by amikacin (93.9%) and piperacillin/tazobactam (87.7%). Susceptibility rates of ceftriaxone, cefotaxime, ceftazidime, and cefepime against Enterobacteriaceae were 38.3%, 38.3%, 61.1%, and 50.8%, respectively. The leastactive agent against Enterobacteriaceae was ampicillin/sulbactam (25.9%). The extended-spectrum β-lactamase (ESBL) rates among E. coli, K. pneumoniae, Klebsiella oxytoca, and Proteus mirabilis were 68.8%, 38.1%, 41.2%, and 57.7%, respectively. Conclusions Enterobacteriaceae were the major pathogens causing IAIs, and the most active agents against the study isolates (including those producing ESBLs) were ertapenem, imipenem, and amikacin. Including the carbapenems, most agents exhibited reduced susceptibility against ESBL-positive and multidrug-resistant isolates.
The Lancet Infectious Diseases, 2011
Background Patients admitted to intensive-care units are at high risk of health-care-associated infections, and many are caused by antimicrobial-resistant pathogens. We aimed to assess excess mortality and length of stay in intensivecare units from bloodstream infections and pneumonia. Methods We analysed data collected prospectively from intensive-care units that reported according to the European standard protocol for surveillance of health-care-associated infections. We focused on the most frequent causative microorganisms. Resistance was defi ned as resistance to ceftazidime (Acinetobacter baumannii or Pseudomonas aeruginosa), third-generation cephalosporins (Escherichia coli), and oxacillin (Staphylococcus aureus). We defi ned 20 diff erent exposures according to infection site, microorganism, and resistance status. For every exposure, we compared outcomes between patients exposed and unexposed by use of time-dependent regression modelling. We adjusted results for patients' characteristics and time-dependency of the exposure. Findings We obtained data for 119 699 patients who were admitted for more than 2 days to 537 intensive-care units in ten countries between Jan 1, 2005, and Dec 31, 2008. Excess risk of death (hazard ratio) for pneumonia in the fully adjusted model ranged from 1•7 (95% CI 1•4-1•9) for drug-sensitive S aureus to 3•5 (2•9-4•2) for drug-resistant P aeruginosa. For bloodstream infections, the excess risk ranged from 2•1 (1•6-2•6) for drug-sensitive S aureus to 4•0 (2•7-5•8) for drugresistant P aeruginosa. Risk of death associated with antimicrobial resistance (ie, additional risk of death to that of the infection) was 1•2 (1•1-1•4) for pneumonia and 1•2 (0•9-1•5) for bloodstream infections for a combination of all four microorganisms, and was highest for S aureus (pneumonia 1•3 [1•0-1•6], bloodstream infections 1•6 [1•1-2•3]). Antimicrobial resistance did not signifi cantly increase length of stay; the hazard ratio for discharge, dead or alive, for sensitive microorganisms compared with resistant microorganisms (all four combined) was 1•05 (0•97-1•13) for pneumonia and 1•02 (0•98-1•17) for bloodstream infections. P aeruginosa had the highest burden of health-care-acquired infections because of its high prevalence and pathogenicity of both its drug-sensitive and drug-resistant strains. Interpretation Health-care-associated bloodstream infections and pneumonia greatly increase mortality and pneumonia increase length of stay in intensive-care units; the additional eff ect of the most common antimicrobial resistance patterns is comparatively low. Funding European Commission (DG Sanco).
Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017
JAMA, 2020
Infection is frequent among patients in the intensive care unit (ICU). Contemporary information about the types of infections, causative pathogens, and outcomes can aid the development of policies for prevention, diagnosis, treatment, and resource allocation and may assist in the design of interventional studies. OBJECTIVE To provide information about the prevalence and outcomes of infection and the available resources in ICUs worldwide. DESIGN, SETTING, AND PARTICIPANTS Observational 24-hour point prevalence study with longitudinal follow-up at 1150 centers in 88 countries. All adult patients (aged Ն18 years) treated at a participating ICU during a 24-hour period commencing at 08:00 on September 13, 2017, were included. The final follow-up date was November 13, 2017. EXPOSURES Infection diagnosis and receipt of antibiotics. MAIN OUTCOMES AND MEASURES Prevalence of infection and antibiotic exposure (cross-sectional design) and all-cause in-hospital mortality (longitudinal design). RESULTS Among 15 202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [60.4%]), infection data were available for 15 165 (99.8%); 8135 (54%) had suspected or proven infection, including 1760 (22%) with ICU-acquired infection. A total of 10 640 patients (70%) received at least 1 antibiotic. The proportion of patients with suspected or proven infection ranged from 43% (141/328) in Australasia to 60% (1892/3150) in Asia and the Middle East. Among the 8135 patients with suspected or proven infection, 5259 (65%) had at least 1 positive microbiological culture; gram-negative microorganisms were identified in 67% of these patients (n = 3540), gram-positive microorganisms in 37% (n = 1946), and fungal microorganisms in 16% (n = 864). The in-hospital mortality rate was 30% (2404/7936) in patients with suspected or proven infection. In a multilevel analysis, ICU-acquired infection was independently associated with higher risk of mortality compared with community-acquired infection (odds ratio [OR], 1.32 [95% CI, 1.10-1.60]; P = .003). Among antibiotic-resistant microorganisms, infection with vancomycin-resistant Enterococcus (OR, 2.41 [95% CI, 1.43-4.06]; P = .001), Klebsiella resistant to β-lactam antibiotics, including third-generation cephalosporins and carbapenems (OR, 1.29 [95% CI, 1.02-1.63]; P = .03), or carbapenem-resistant Acinetobacter species (OR, 1.40 [95% CI, 1.08-1.81]; P = .01) was independently associated with a higher risk of death vs infection with another microorganism. CONCLUSIONS AND RELEVANCE In a worldwide sample of patients admitted to ICUs in September 2017, the prevalence of suspected or proven infection was high, with a substantial risk of in-hospital mortality.
Bacterial Susceptibility Patterns of Pathogens in Icu in Tertiary Care
2020
Introduction: Globally antibiotic resistant pathogens are encountered in Intensive Care Unit (ICU). ICU plays important role in the management of critically ill patients and treatment of the infections. In ICU antibiotics susceptibility and resistance play an important role in the management of infection. Emergence of the antibiotic resistance is becoming increasingly difficult problem in ICU. In ICU, nosocomial infections with multi-drug resistant strains are becoming important cause of morbidity and mortality compared with an average patient. The source for multi-drug resistant bacteria may include repeated use of higher antibiotics, poor hand hygiene, reuse of items used for individual patients, lack of environmental cleaning, resource management and education and surveillance. Aim: To know prevalence of the drug resistance patterns for the patients admitted in ICUs. Material and Methods: The study was done on 106 isolates from ICU of 40 patients. It was conducted at the Departme...
Official Journal of the Association of Medical Microbiology and Infectious Disease Canada, 2016
BACKGROUND: Using different indicators and definitions, the present study aimed to describe population antimicrobial use, as well as prevalence and incidence of clinically relevant antimicrobial resistances found in respiratory cultures performed in intensive care unit (ICU) patients. Results obtained with the various methodologies were then compared. METHODS: The present retrospective cohort study included all patients admitted to nine ICUs between April 2006 and March 2010. Prevalence and incidence of clinically relevant resistances in respiratory cultures were described and population antimicrobial use was measured using 10 different indicators based on dosage, duration of treatment, or exposure to antimicrobials. RESULTS: Indicators had variable sensitivity to detect time trends and differences among ICU types. However, the highest prevalence and incidence rates in respiratory isolates were in Staphylococcus aureus resistance to oxacillin (0.52% of ICU admissions and 6.57 acquis...
Pharmaceutical Sciences Asia
Antimicrobial resistance (AMR) has become a concerning health issue worldwide, and this resistance leads to poor treatment outcomes and high mortality, especially, AMR of NP in ICU. To determine the reality of AMR and find the factors related to AMR of NP in the ICU. We performed a cross-sectional study in the ICU Department from July 2015 to July 2019. We calculated the incidence of the degree of multidrug-resistant strains and the percentages of factors related to AMR. Data management and analysis were performed by SPSS version 22.0. Of the initial observation of 281 patients, all participants had NP due to gram-negative bacteria; 91 (32.4%) were early-onset and 190 (67.6%) were lately-onset NP. Out of all pathogens examined, above 80% were resistant to quinolone, carbapenem, and cephalosporin. Moreover, multiple drug resistance in bacteria was about 87.5%. Furthermore, bacteria, changed antibiotics have been significantly associated with the multi-resistance of bacteria. Besides, the increase in antibiotic use, especially ciprofloxacin and imipenem, is also related to antibiotic resistance. These results show that the resistance to quinolones, carbapenem, and cephalosporin is high in the ICU, with rates exceeding 80%. Furthermore, the bacteria, change of antibiotics, and the increasing use of antibiotics have been significantly associated with multiple antibiotic resistance.
THE PROFESSIONAL MEDICAL JOURNAL, 2016
Infections occurring more than 48 hours after admission in hospital are usually considered as nosocomial infections. Patients in ICUs are at a higher risk of acquiring this infection than those in non-critical areas. The total length of stay increased from three days to nineteen days for clinical procedures. Increased antimicrobial resistance in such cases makes increase in mortality and morbidity. The ICU infection rates is five to ten times higher than HAIs in ward patients. ICU acquired infections are major health problem globally, in developing countries like Pakistan. The microorganisms that are frequently isolated from intensive care units are Acinetobacter spp, P. aeruginosa, Klebsiella pneumoniae, Streptococcus spp, Staphylococcus spp, Enterococci and Enterobacteriaceae i.e E. coli, Proteus mirabilis and Serratia marcescens. Aims: The present study was aimed at to determine the frequency of causative organisms in intensive care unit (ICU) patients and antimicrobial susceptibility pattern of the isolates. Study Design: A cross-sectional study. Place and Duration of Study: Microbiology section of Pathology department Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Four months (September to December 2015). Materials and Methods: Clinical samples from patients having signs and syptoms of site-specific infections or fever in ICU were collected. The samples were cultured on suitable culture media and bacterial isolates were identified by Gram stain and standard biochemical methods. Antimicrobial susceptibility testing to conventional and newer antibiotics was performed on Mueller Hinton agar using disc diffusion method. Frequency percentages of all isolates were determined. Results: Out of 100 samples only 30 samples were positive for growth and 70 samples showed no growth. The most frequent isolates were E. coli (40%), K. pneumoniae (10%) P. aeruginosa (10%) Proteus spp. (20%) Acinetobacter (17%) and S.aureus (3%). S.aureus (Gram positive bacteria) were more sensitive to imipenem, cefoxitin and resistant to ceftriaxone, nitrofurantoin azithromycin, Tetracycline, Cefotaxime and amoxicillin clavulanic acid. Other Gram negative bacteria i.e E.coli, K. Pneumoniae, P.aeruginosa, Proteus spp. and Acinetobacter spp. were sensitive to imipenem, sulzone, ceftriaxone, Ciprofloxacin, Gentamicin, Nitrofurantoin and resistant to amoxicillin clavulanic acid. Conclusion: Bacteria were isolated from 30% clinical samples taken from patients admitted in ICU. The most frequent site of infection was the respiratory tract followed by urinary tract and blood stream infections. E. coli, P. aeruginosa, K. pneumonia, Proteus spp., Acinetibacter and S. aureus were isolated. The high frequency of Health associated infections and elevated bacterial resistance rate in ICU patients suggest that more strict measures regarding infection control practices can be done.
Infection and Drug Resistance
Introduction: Management of ventilator-associated pneumonia (VAP), the most common infection in patients on mechanical ventilation, should be tailored to local microbiological data. The aim of this study was to determine susceptibility patterns of organisms causing VAP to develop a treatment algorithm based on these findings and evidence from the literature. Materials and methods: This is a retrospective analysis of the microbiological etiology of VAP in the intensive care unit (ICU) of a Lebanese tertiary care hospital from July 2015 to July 2016. We reviewed the latest clinical practice guidelines on VAP and tried to adapt these recommendations to our setting. Results: In all, 43 patients with 61 VAP episodes were identified, and 75 bacterial isolates caused VAP. Extensively drug-resistant (XDR) Acinetobacter baumannii was the most common organism (37%), and it had occurred endemically throughout the year. Pseudomonas aeruginosa was the next most common organism (31%), and 13% were XDR. Enterobacteriaceae (15%) and Stenotrophomonas maltophilia (12%) shared similar incidences. Our algorithm was based on guidelines, in addition to trials, systematic reviews, and meta-analyses that studied the effectiveness of available antibiotics in treating VAP. Conclusion: Knowing that resistance can rapidly develop within a practice environment, more research is needed to identify the best strategy for the management of VAP.
Indian Journal of Critical Care Medicine, 2011
Background: Lower respiratory tract infections (LRTIs) are the most frequent infections among patients in intensive care units (ICUs). Aim: To track the resistance rate among the causative agents causing LRTI in the ICU patients. Design and Settings: This is a retrospective study done in a tertiary care hospital. Materials and Methods: Transtracheal or bronchial aspirates from 2776 patients admitted to the ICU were cultured and identified, and antibiotic sensitivity was performed by standard methods. Results: Of 2776 specimens, 1233 (44.41%) isolates were recovered, of which 1123 (91.07%) were gram-negative bacilli (GNB) and 110 (8.92%) were gram-positive organisms. From 2004 to 2009, Pseudomonas aeruginosa remained the most common pathogen. In phase I, high level of resistance (79-98%) was observed against all GNB. During phase II increasing trend in resistance to cephalosporins and declining trend in resistance to aminoglycosides against most GNB were observed. Multidrug resistance (resistance to three or more than three drugs) was observed in 83% of total isolates. Conclusions: Gram-negative organisms are the predominant pathogens causing LRTI in ICU. The increasing trend of resistance to cephalosporins and carbapenems in gram-negative organisms is very disturbing. Judicious use of antimicrobial agents is essential to prevent the emergence of multidrug-resistant bacteria in the ICU.