Recent Advances in Investigation, Prevention, and Management of Healthcare-Associated Infections (HAIs): Resistant Multidrug Strain Colonization and Its Risk Factors in an Intensive Care Unit of a University Hospital

Abstract

Active screening for resistant multidrug strain carriers remains an important component of infection control policy in any healthcare setting indifferent of financial and logistical costs. The objective of our study was to determine the spectrum of bacterial colonization individually among intensive care unit patients. A retrospective observational study was performed in the Intensive Care Unit of Emergency Clinical County Hospital of Oradea during 2017. Medical records of the patients were used for evaluation of source of ICU admission, previous antibiotic therapy, comorbidities, and length of hospital stay. Nasal and groin swabs for MRSA detection and rectal swabs for ESBL, VRE, and CRE detection were collected upon ICU admission of all patients in the first 24 hours and after 7 days. Swab samples were processed for isolation and identification of these resistant multidrug strains. Bacterial colonization on admission was detected in a quarter of patients included in the study. Carbapenemase-producing bacteria were the most common colonizers (21.16%). On admission, 12.06% of patients have been colonized by ESBL-producing members of the family Enterobacterales. Risk factors for colonization on admission to the ICU were chronic liver diseases and chronic renal failure for ESBL infection and chronic liver disease for CRE in male patients. Evaluation of Carmeli’s score for male patients showed association only with CRE colonization. Chronic renal failure was found as risk factor for ESBL colonization in female patients. The prevalence of MRSA was 5.23% and less than 1% for VRE. There was no association between any risk factors studied and the presence of S. aureus or VRE upon admission. The 7-day ICU stay also proved to be an increased risk for ESBL and CRE infection.

Clinical, Pathological and Microbiological Evaluation of Diabetic Foot Syndrome

“…Carriages or infections with MDR pathogens result in less treatment options and high mortality rates in patients. Skin and soft tissue infections, including DFUs, have increased every year, the frequency of antimicrobial MDR organisms-not only MRSA but, also, vancomycin-resistant enterococci (VRE)-extended spectrum beta-lactamase-producing and carbapenemase-producing Gram-negative organisms [45,46]. Obtained data showed 15 strains of ESBL that accounted for 8.02% of the Gram-negative bacilli, and most of them were Escherichia coli; these strains presented the highest susceptibility to carbapenems, followed by amikacin, levofloxacin and piperacillin-tazobactam.…”

“…Costs related to microbiological testing are variable with the method used, confirmation of a strain with a resistance phenotype, therapeutic options, etc. The Kirby-Bauer disk diffusion method (that uses a number of eight antibiotics, from different classes, for testing the susceptibility of the pathogen to antimicrobials) has a lower cost than the one using Vitek-2 Compact Systems (as is specified in Section 2 , it brings sufficient therapeutic options in the case of a patient with DFU onset) [ 45 , 46 ]. Infections with MDR pathogens or relapse of the disease need additional testing to confirm the resistance phenotype and more expensive therapeutic options.…”

Community-acquired Klebsiella pneumoniae systemic infection complicated with rhombencephalitis

“…(26) ICU-acquired infection is defined if the pathogen colonies are detected on screening swabs samples 7 days after ICU admission, in previously negative patients. (27) In our case, community-acquired bacteriemia was associated with an ICU-acquired infection (K.pneumoniae CRE and ESBL), leading to poor prognosis.…”

Antibiotic Consumption and Microbiological Epidemiology in Surgery Departments: Results from a Single Study Center

“…A special group of pathogens called ESKAPE (Enterobacter spp., Staphylococcus aureus, Klebsiella spp., Acinetobacter baumannii, P. aeruginosa, Enterococcus spp.) is the cause of most healthcare-associated infections and demonstrate concerning patterns of antibiotic resistance and the patients' colonization by these strains is not negligible at all [5,6]. The European Centre for Disease Prevention and Control (ECDC) has confirmed that the trend in some European countries, including Romania is the increase of antimicrobial resistance even though not all hospitals reported it.…”