The World Health Organization (WHO) proposed a global priority pathogen list (PPL) of multidrug resistant (MDR) bacteria. Our current objective was to provide global expert ranking of the most serious multi-drug resistant (MDR) bacteria present at intensive care units (ICU) that have become a threat in clinical practice. Methods: A proposal addressing a pathogens priority list (PPL) for ICU, arising from the WHO Global PPL was developed. Based on the supporting data, the pathogens were grouped in three priority tiers: Critical, high and medium. A multi-criteria decision analyses (MCDA) was used to identify the priority tiers. Results: After MCDA analysis, mortality, treatability and cost of therapy were of highest concern (scores of 19/20, 19/20 and 15/20, respectively) while dealing with PPL, followed by healthcare burden and resistance prevalence. Carbapenen-resistant (CR) Acinetobacter baumannii, Carbapenemaseexpressing Klebsiella pneumoniae (KPC) and MDR Pseudomonas aeruginosa were identified as critical organisms. High risk organisms were represented by CR Pseudomonas aeruginosa, Methicillinresistant Staphylococcus aureus, and Extended Spectrum Beta lactamase(ESBL) Enterobacteriaceae. Finally, ESBL Serratia marcescens, Vancomycin-resistant Enterococci and TMP-SMX resistant Stenotrophomonas maltophilia were identified as medium priority. Conclusions: We conclude that education, investigation, funding and development of new antimicrobials for ICU organisms should focus on Carbapenem-resistant Gram negative organisms.
The purpose of this paper was to report the burden and characteristics of infection by multidrug-resistant Pseudomonas aeruginosa (MDR-PA) in clinical samples from intensive care unit (ICU) adults, and to identify predictors. This was a retrospective observational study at four medical-surgical ICUs. The case cohort comprised adults with documented isolation of an MDR-PA strain from a clinical specimen during ICU stay. Multivariate analysis was performed to identify predictors for MDR-PA infection. During the study period, 5667 patients were admitted to the ICU and P. aeruginosa was isolated in 504 (8.8%). MDR-PA was identified in 142 clinical samples from 104 patients (20.6%); 62 (43.6%) of these samples appeared to be true infections. One hundred and eighteen (83.1%) isolates were susceptible only to amikacin and colistin, and 13 (9.2%) were susceptible only to colistin. Overall, the MIC to meropenem was 16 μg/mL and the MIC was >32 μg/mL, with 60.4% of respiratory samples being MIC >32 μg/mL to meropenem. Independent predictors for MDR-PA infection were fever/hypothermia [odds ratio (OR) 9.09], recent antipseudomonal cephalosporin therapy (OR 6.31), vasopressors at infection onset (OR 4.40), and PIRO (predisposition, infection, response, and organ dysfunction) score >2 (OR 2.06). This study provides novel information that may be of use for the clinical management of patients harboring MDR-PA and for the control of the spread of this organism.
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