ABSTRACT

To identify and to determine the resistance pattern of bacterial pathogens involved in infections of the elderly patients (� 65 years) admitted in the intensive care unit (ICU) at County Emergency Clinical Hospital Craiova, Romania. A retrospective study of bacterial pathogens was carried out on 463 elderly patients (� 65 years) admitted to the ICU, from January to December 2017. The analysis of the resistance patterns for the action of the appropriate antibiotics was performed using Vitek 2 Compact system and diffusion method. In this study there were analyzed 617 samples from 463 elderly patients (� 65 years). A total of 776 bacterial isolates were obtained, of which 175 strains of Klebsiella spp. (22.55%), followed by MRSA - Methicillin-Resistant Staphylococcus Aureus (108 -13.91%) and Escherichia coli (99 -12.75%). The most common isolates were from respiratory tract (572 isolates -73.71%). High rates of MDR were found for Pseudomonas (73.07%), MRSA (62.03%) and Klebsiella (44.57%). The study revealed an alarming pattern of antibiotic resistance in the majority of ICU isolates from elderly patients (�65 years), which draws attention to the need for judicious use of antibiotics and for careful monitoring of the drug resistance of patients.

Introduction Bloodstream infections are the most severe infections that cause the highest mortality rate, especially in patients admitted to the intensive care unit (ICU). In this study, we aimed to analyze the distribution, resistance patterns and prevalence of MDR (multidrug-resistant) pathogens isolated in blood samples collected from patients with severe invasive infections hospitalized in the ICU. Methods A retrospective study of bacterial pathogens was performed on 490 patients admitted to the ICU between 2017 and 2020. The resistance patterns were analyzed using Vitek 2 Compact system. Results In total, 617 bacterial isolates were obtained. Four hundred and twenty-seven isolates (69.21%) were Gram positive and 190 isolates (30.79%) were Gram negative bacteria. The most frequently isolated micro-organisms identified in the blood samples for the entire period (2017–2020) were Coagulase-negative staphylococci (CoNS) (318–51.54%), followed by Klebsiella pneumoniae (70–11.34%), Methicillin-Resistant Staphylococcus aureus (MRSA) (58–9.40%), Acinetobacter baumannii (45–7.29%) and Enterococcus faecalis (42–6.80%). The number of Klebsiella pneumoniae strains significantly increased in 2020, compared to the previous year (p < 0.05). The Acinetobacter baumannii prevalence was significantly higher in the age group of 20–64 years (10.89%) and over 65 years (3.53%) (p < 0.001). The difference between the prevalence of CoNS in the elderly (67.84%) and in adults (20–64 years) (52.47%) was also statistically significant (p < 0.001). High rates of MDR were found for Acinetobacter baumannii (97.77%), Pseudomonas aeruginosa (65%), Klebsiella pneumoniae (50%), Enterococcus faecalis (47.61%) and MRSA (46.55%). More than 60% of the Klebsiella pneumoniae strains were found to be resistant to carbapenems. Conclusion The study revealed an alarming prevalence of MDR strains isolated in blood samples of the patients admitted to the ICU, indicating the necessity of consistent application of the measures to control.

The emergence of multidrug-resistant (MDR) pathogens, especially for intensive care unit (ICU) patients is a serious threat to public health. To determine the frequency and antibiotic resistance pattern of bacterial pathogens isolated from tracheal aspirates of the patients admitted in ICU. The retrospective study included endotracheal aspirates from 734 patients admitted to the ICU, from January to December 2017. The analysis of the resistance patterns for the action of the appropriate antibiotics was performed using Vitek 2 Compact system and diffusion method. A total of 985 bacterial isolates were obtained, of which 227 strains of Klebsiella spp. (23.04%), followed by Nonfermenting Gram negative bacilli, other than Pseudomonas and Acinetobacter (NFB) (170- 17.25%), MRSA (134- 13.60%). Isolation rates indicates a higher value for male patients and elderly patients (over 65 years), statistically significant. High rates of MDR were found for Klebsiella spp. (70.04%) and Pseudomonas aeruginosa (66.25%) while almost all of the isolated NFB strains were MDR (98.82%). The study revealed high rates of MDR pathogens in the majority of ICU isolates which may be due to unnecessary use of higher generations of antibiotics, use of mechanical devices, age, comorbidities, and can determine a higher rate of morbidity and mortality among these patients.

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