Evaluating the Prevalence and the Risk Factors of Gram-Negative Multi-Drug Resistant Bacteria in Eastern Saudi Arabia

Abstract

Purpose Multidrug-resistant organisms (MDROs) among Gram-negative bacteria (GNB) are a major public health concern worldwide, which can even lead to death. This study was conducted to determine the prevalence of MDROs among isolated GNB in the Security Forces Hospital Dammam (SFHD) and identify its associated risk factors. Materials and Methods A cross-sectional study was performed on the most commonly isolated GNB in SFHD, Acinetobacter spp., Enterobacter spp., Escherichia coli ( E. coli ), Klebsiella pneumoniae , Proteus spp., and Pseudomonas aeruginosa , of non-duplicated clinical samples collected from all hospital units throughout the period from January 2017 to December 2018. Data were collected retrospectively from patients’ medical records, and analyses were conducted using the chi-square test and logistic regression models. Results Of the 1508 GNB included in the study, 969 were multidrug-resistant (MDR; 64.3%). The most commonly identified multidrug-resistant GNB (MDR-GNB) were found in female patients (66.4%) and those aged between 20 and 29 years (21.8%). Urine samples had the highest number of isolated GNB (926 of a total of 1508, 61.4%), and E. coli isolates (53.8%) were the most frequently isolated GNB. Enterobacter spp. had the highest rate of multidrug resistance during the 2 years (64 out of 74, 86.5%). Mechanical ventilation for three or more calendar days was a significant direct risk factor for the development of MDR-GNB (odds ratio [OR]: 2.600, 95% confidence interval [CI]: 1.124–6.012, P = 0.025). Conclusion Multidrug resistance is common among GNBs in SFHD. Antimicrobial stewardship programs in hospitals should be supported and implemented. Medical and public awareness of antibiotic use is another significant way to decrease the burden of MDR.

Multidrug-Resistant Gram-Negative ESKAPE Pathogens from a Tertiary-Care Hospital: Prevalence and Risk Factors

“…In addition, patients submitted to mechanical ventilation (P= 0.005) were at a greater risk (Table 4). These findings align with the results described by Al Hamdan et al 17 . Undergoing surgical intervention was another independent predictor for MDR Gram-negative ESKAPE infections, which corroborates other researchers 30 .…”

“…In our univariate analysis, increased age beyond 60 years was significantly associated with acquiring MDR Gram-negative ESKAPE infections (P= 0.009), similar to another study from Saudi Arabia 17 . In elderly patients, jeopardized immune system sets them at a higher risk for hospitalization and having infections with virulent strains, including antibiotic-resistant bugs.…”

“…This observation is supported by recent literature from the Ministry of National Guard Health Affairs of Saudi Arabia 16 . On the flip side, data from Eastern Saudi Arabia highlighted that MDR Acinetobacter species were the least common isolates; however, recruitment of patients from all age groups, as well as attendees of the outpatient clinics are likely explanations to this incongruence 17 .…”

Intrinsic Resistance: A Significant Characteristic in Evaluating Antibiotic Sensitivity Pattern [Letter]

“…2 Moreover, the intrinsic resistance is highly important as it along with other resistance mechanism may result in poor clinical outcome. 4 , 5 Further, this study reported 16.7% (1 out of 6 strains) resistance in Streptococcus pneumoniae to penicillin. However, CLSI guidelines have not recommended to report penicillin resistant S. pneumoniae strains on the basis of disk diffusion method(s).…”

“…2 Moreover, the intrinsic resistance is highly important as it along with other resistance mechanism may result in poor clinical outcome. 4 , 5 …”