Nosocomial sepsis and drug susceptibility pattern among patients admitted to adult intensive care unit of Ayder Comprehensive Specialized Hospital, Northern Ethiopia

Abstract

Objective Developing nosocomial sepsis within intensive care unit (ICU) is associated with increased mortality, morbidity, and length of hospital stay. But information is scarce regarding nosocomial sepsis in intensive care units of Northern Ethiopia. Hence, this study aims to determine the incidence of nosocomial sepsis, associated factors, bacteriological profile, drug susceptibility pattern, and outcome among patients admitted to the adult ICU of Ayder Comprehensive Specialized Hospital (ACSH), which is the largest tertiary hospital in Northern Ethiopia. Method Facility-based longitudinal study was conducted by following 278 patients who were admitted for more than 48 h to adult ICU of ACSH, from October 2016 to October 2017. Data were collected from charts, electronic medical records, and microbiology registration book using a checklist. The collected data were subjected to descriptive statistics and multivariable logistic regression using SPSS version 25. Statistical significance was declared at p < 0.05. Result Of all the patients, 60 (21.6%) of them acquired nosocomial sepsis. The risk of mortality was about two times higher among adult ICU patients who acquired nosocomial sepsis (RR = 2.2; 95% CI of RR = 1.3–3.5; p = 0.003). The odds of acquiring nosocomial sepsis among those who were on a mechanical ventilator (MV) and stayed more than a week were 5.7 and 9.3 times higher, respectively, than their corresponding counterparts. Among 48 isolates, Klebsiella was the most common pathogen. The isolates had a broad antibiotic resistance pattern for cephalosporins, penicillins, and methicillin. Conclusion The incidence of nosocomial sepsis in the adult ICU patients of ACSH was higher when compared to the incidence reported from some African and Asian countries. Mortality was higher among patients who acquired nosocomial sepsis. Use of MV and longer length of ICU stay were the significant predictors of nosocomial sepsis. The isolates were resistant to several antibiotics. Therefore, strict application of infection prevention strategies and appropriate use of antibiotics is so crucial. As well, priority should be given to patients who develop nosocomial sepsis in ICU.

The magnitude of mortality and its determinants in Ethiopian adult intensive care units: A systematic review and meta-analysis

“…Studies included were conducted in Ethiopia and published in journals that are indexed. Based on the region, three studies were conducted in Addis Ababa [ 34 , 38 , 40 ], three studies in Amhara [ 37 , 44 , 46 ], four studies in Oromia [ 11 , 36 , 42 , 45 ],.two studies in Southern Nations, Nationalities, and Peoples (SNNP) [ 35 , 41 ], and two studies in Tigray [ 39 , 43 ]. Seven studies were cross-sectional, four studies were cohort (retrospective and prospective), two studies were longitudinal, and one study was prospective observational.…”

“…Ethiopia had 114 million people and 51 intensive care units with only 324 intensive care unit beds, resulting in a national ICU bed-to-population ratio of 0.3 per 100,000 people [ 33 ]. According to various studies conducted in Ethiopia, the mortality rate following ICU admission was high, ranging between 18.3 and 67.4% [ 11 , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] ]. Among factors related to the resources of a hospital that contribute to the mortality of patients in ICU include training and skills of medical staff, nurse-to-patient ratio, infrastructure, and shortage of essential drugs and equipment [ 47 ].…”

Risk factors associated with positive bacterial culture in salvaged red blood cells during cardiac surgery and postoperative infection incidence: A prospective cohort study

“…As it can readily form a biofilm, S. epidermidis can resist antibiotic treatment, contributing to persistent or prolonged infections. The majority of bacteria isolated from bloodstream infection patients are Gram-positive bacteria, including coagulase (−) bacteria such as S. epidermidis ( 19 ), which is a common causative agent in cases of nosocomial blood infections ( 20 ). S. epidermidis was previously reported to be associated with 69% of culture (+) in sRBCs following the CS-mediated washing of salvaged blood for patients undergoing cardiac surgery.…”

Critical Care Database Comprising Patients With Infection

“…Infection is common in the intensive care unit ( 1 , 2 ). There are two categories of infections for patients in the intensive care unit (ICU) due to the place where the infection was acquired.…”

“…One type of infection is the infection present on ICU admission, and most of such patients are transferred to ICU due to the development of sepsis and/or septic shock ( 3 , 4 ). The other type of infection is the infection acquired after ICU admission, which is also termed the nosocomial infection ( 1 ). Critically ill patients are at increased risk of infection because of compromised immunity, use of intravascular catheters, and endotracheal intubation ( 5 , 6 ).…”