High Prevalence of Antimicrobial Resistance Among Gram-Negative Isolated Bacilli in Intensive Care Units at a Tertiary-Care Hospital in Yucatán Mexico

Abstract

Background and Objectives: Antimicrobial resistance (AMR) is increasing worldwide and imposes significant life-threatening risks to several different populations, especially to those in intensive care units (ICU). The most commonly isolated organisms in ICU comprise gram-negative bacilli (GNB), and these represent a leading cause of serious infections. This study was conducted to describe the prevalence of resistance in GNB isolated from patients in adults, pediatric, and neonatal ICU in a tertiary-care hospital in Mérida, Mexico. Materials and Methods: A retrospective study was done on samples collected in Neonatal (NICU), Pediatric (PICU) and Adult (AICU) ICU of Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social in Mérida, México. The identification of isolates and antimicrobial susceptibility testing were performed using an automated system. Results: A total of 517 GNB strains were isolated. The most common positive culture was bronchial secretions. Pseudomonas aeruginosa was the prevalent pathogen in NICU and PICU, whereas Escherichia coli was common in the AICU. Overall, GNB exhibited a high resistance rates for Ampicillin (95.85%), Cefuroxime (84.17%), Piperacillin (82.93%), Cefotaxime (78.07%), Ceftriaxone (77.41%), Aztreonam (75.23%), Cefazolin (75.00%), and Ceftazidime (73.19%). There are significant differences in the resistance rates of GNB from different ICUs for penicillins, cephalosporins, carbapenems and fluoroquinolones drugs. Escherichia coli (multidrug-resistant [MDR] = 91.57%, highly resistant microorganisms [HRMO] = 90.36%) and Acinetobacter baumannii (MDR = 86.79%, HRMO = 83.02%) exhibited the highest percentage of MDR and HRMO profiles. The prevalence of the extended-spectrum beta-lactamases (ESBL)-producing isolates was 83.13% in E. coli, 78.84% in Klebsiella pneumoniae, and 66.67% in Proteus mirabilis, respectively. Conclusions: The high resistance rates to drugs were exhibited by our GNB isolates. Continuous surveillance and control of the use of antimicrobials are urgently needed to reduce the emergence and spreading of MDR, HRMO, and/or ESBL-producing bacilli.

Extended-Spectrum β-Lactamase and Carbapenemase Producing Gram-Negative Bacilli Infections Among Patients in Intensive Care Units of Felegehiwot Referral Hospital: A Prospective Cross-Sectional Study

“…The most prevalent cultured confirmed infections in the present study were lower respiratory tract infections and wound infections which are reliable with studies from Mexico 28 and Southern India, 34 where most of the infections were lower respiratory tract infections and wound infections. This might be due to the high chance of exposure to hospital pathogens during care and following the use of mechanical ventilation and other supportive devices for intensive care.…”

“…The prevalence of GNB infection (35.2%) among ICU patients in the present study was analogous with studies from Uganda (32%) 6 and India (37%). 26 However, it was higher than other studies done in Ethiopia (25.13%), 27 Mexico (19%), 28 Nipa (19.5%) 29 and Nepal (12.6%). 30 Conversely, a high percentage of infections had been reported in Bosnia (65.2%), 31 India (62%) 32 and Nigeria (50.9%).…”

“…The prevailing prevalence of MDR is in accord with studies done in Uganda (58%), 6 India (72.5%), 26 Nepal (62.1% and 79%) 30 , 46 and Mexico (70.96%). 28 The high burden of MDR isolates in the present study could be associated with empirical and non-selective use of antibiotics, irrational dose regimens, and the transfer of MDR determining genes among the isolates. Furthermore, mutations in the chromosome might result in over production of ESBLs, over-expression of efflux pumps, target modifications and permeability alterations.…”

“…This is consistent with findings reported in Indonesia, 39 Algeria 40 and India 37 where E. cloacae was the predominant ESBL producing isolate. In reports from Uganda, 6 Nepal, 30 Brazil 41 and Mexico, 28 E. coli and K. pneumoniae were also the most common ESBL producing isolates. Moreover, 56.6–81.3% of GNB isolates from blood, urine, sputum and wound samples of the present study are ESBL producers.…”

Detection of Multidrug-resistant Extended-spectrum Beta-lactamase-producing Enterobacteria from Community Infections in the city of Reynosa, Tamaulipas Mexico

“…Discussion ESBL-mediated resistance in Enterobacteriaceae is one of the greatest threats to public health at present, increasing morbidity and mortality of many infectious diseases, in addition to increasing health costs. There are different reports in Mexico regarding the presence and mobility of ESBL-producing strains and the genes associated with their production [12,19,21,22,2,25]. However, in the northeast region of Mexico only the environmental distribution of these organisms has been elucidated [20].…”