Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt

Abstract

IntroductionThe prevalence of extensively drug resistant gram negative bacilli (XDR-GNB) is rapidly progressing; however in Egypt data are sparse. We conducted the present study to quantify the incidence, risk factors and outcome of patients harboring XDR-GNB.MethodsA one year prospective study was done by collecting all the bacteriological reports for cultures sent from the surgical intensive care unit, Cairo university teaching hospital. XDR-GNB were defined as any gram negative bacilli resistant to three or more classes of antimicrobial agents. Patients with XDR-GNB compared with those sustaining non extensively drug-resistant infection. A multivariate logistic regression model was created to identify independent predictors of multi-resistance.ResultsDuring one-year study period, a total of 152 samples (65%) out of 234 gram negative bacilli samples developed extensively drug resistant infection. XDR strains were significantly higher in Acinetobacterspp (86%), followed by Pseudomonas (63%), then Proteus (61%), Klebsiella (52%), and E coli (47%). Fourth generation cephalosporine (Cefipime) had the lowest susceptibility (10%) followed by third generation cephalosporines (11%), Quinolones (31%), Amikacin (42%), Tazobactam (52%), Carbapinems (52%), and colistin (90%). Relaparotomy was the only significant risk factor for acquisition of XDR infection.ConclusionExtensively drug-resistant gram negative infections are frequent in our ICU. This is an alarming health care issue in Egypt which emphasizes the need to rigorously implement infection control practices.

Multidrug-resistant profile and prevalence of extended spectrum β-lactamase and carbapenemase production in fermentative Gram-negative bacilli recovered from patients and specimens referred to National Reference Laboratory, Addis Ababa, Ethiopia

“…More MDR and XDR strains in E. coli than K. pneumoniae in our study could be due to the fact that the number of E. coli strains isolated were more than K. pneumoniae. In regard to XDR and PDR, the current study is supported by the findings of previous studies [30, 31] however our finding strongly disagree with a study conducted by Ahmed Hasanin et al [32] in the prevalence of XDR strains of FGNB. In this study lower XDR E. coli (18%) and K. pneumonia (11%) were reported as compared to the previous study where higher XDR K. pneumoniae (52%), and E. coli (47%) were reported [32].…”

“…In regard to XDR and PDR, the current study is supported by the findings of previous studies [30, 31] however our finding strongly disagree with a study conducted by Ahmed Hasanin et al [32] in the prevalence of XDR strains of FGNB. In this study lower XDR E. coli (18%) and K. pneumonia (11%) were reported as compared to the previous study where higher XDR K. pneumoniae (52%), and E. coli (47%) were reported [32]. The reason for the difference in the prevalence of XDR might be due to the definition used to classify isolates into XDR and the location of the patient from (inpatient or outpatient) from where the specimen is obtained.…”

The Role of OmpK35, OmpK36 Porins, and Production of β-Lactamases on Imipenem Susceptibility in Klebsiella pneumoniae Clinical Isolates, Cairo, Egypt

“…According to a study conducted in the surgical ICU of the same hospital, susceptibility to IMI was 88.7% versus 73% in our study. 1 The decreasing IMI susceptibility raised our attention to understand the different mechanisms of IMI resistance in our hospital.…”

Point Prevalence Survey for Screening of Carbapeneme Resistant Enterobacteriaceae in ICU Patients using CDC Protocol and Chromogenic Agar

“…They found that 62% of rectal swabs were positive for CRE. In another study Hasanin et al, (2014) conducted a survey in Egypt for one-year duration, a total of 152 samples (65%) out of 234 gram negative bacilli samples developed extensively drug resistant infection. This high rate of CRE in Egypt is attributed to over the counter antibiotic abuse, noncompliance with antimicrobial stewardships and infection control measures in hospitals.…”