Tracking Epidemiological Characteristics and Risk Factors of Multi-Drug Resistant Bacteria in Intensive Care Units

Abstract

Objectives Multi-drug resistance (MDR) emerged as a serious threat in intensive care unit (ICU) settings. Our study aimed to investigate the major pathogens in ICU and identify the risk factors for MDR infection. Methods We performed a retrospective analysis of patients admitted to the ICU. Multivariate logistic regression was applied to identify the independent predictors, and then a nomogram to predict the probability of MDR infection. Results A total of 278 patients with 483 positive cultures were included. 249 (51.55%) had at least one MDR pathogen, including extensively drug-resistant (XDR) 77 (30.92%) and pan drug-resistant (PDR) 39 (15.66%), respectively. Klebsiella pneumonia was the most frequently isolated pathogen. We identified the number of bacteria (OR 2.91, 95% CI 1.97–4.29, P < 0.001), multiple invasive procedures (OR 2.23, 95% CI 1.37–3.63, P = 0.001), length of stay (LOS) (OR 1.01, 95% CI 1.00–1.02, P = 0.007), Hemoglobin (Hb) (OR 0.99, 95% CI 0.98–1.00, P = 0.01) were independent risk factors for MDR infection. Our nomogram displayed good discrimination with curve AUC was 0.75 (95% CI: 0.70–0.81). The decision curves also indicate the clinical utility of our nomogram. Additionally, the in-hospital mortality with MDR pathogens was independently associated with XDR (HR, 2.60; 95% CI: 1.08–6.25; P = 0.03) and total protein (TP) (HR, 0.95; 95% CI: 0.91–0.99; P = 0.03). Conclusion The number of bacteria, multiple invasive procedures, LOS, and Hb were the independent predictors associated with MDR pathogens. Our nomogram is potentially useful for predicting the occurrence of MDR infection. Besides, we also identify XDR and TP as the independent risk factors for in-hospital mortality with MDR infection. The current prevalence of MDR strains was also described. The results will contribute to the identification and preventive management of patients at increased risk of infection.

Multidrug-resistant gram-negative bacterial infections and associated factors in a Kenyan intensive care unit: A cross-sectional study

“…Further, patients using nasogastric tubes (NGT) were three times at risk of GNB infection in this study. This nding is consistent with Despotovic and others in a 2-year retrospective study in a 15-bed Serbian ICU(33) NGT predisposes to colonization by pathogenic GNB within 48 to 72 hours(34) even within the rst day of use (35) and is a cause of aspiration pneumonia in ventilated patients (30,36)and increased mortality (33).…”

“…In this study, participants with respiratory tract and cardiovascular conditions were about ve and six times, respectively, more likely to have a GNB infection. Different from our nding, risk factors for bacterial infection in ICU patients are documented and include prior antimicrobial therapy, length of ICU stay(37) use of antibiotics, surgery in the month preceding ICU admission, endotracheal intubation( 22) WBC, procalcitonin, urinary catheterization (38), lack of patient isolation precautions, use of Quadri or triple therapy, mechanical ventilation (28), multiple invasive procedures, and haemoglobin level (39). The current study nding is consistent with Chang and others in the emergency ICU at Sichuan Provincial People's Hospital, China.…”

“…In a scoping review of infections and antimicrobial resistance in ICUs in LMICs, Saharman and colleagues found that Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the predominant isolates(6). Klebsiella pneumoniae was the predominant isolate reported from January 2021 to March 2022 in the ICU of the Southern Medical University of Shunde Hospital, Foshan City, Guangdong Province, China (30). In ICUs, the epidemiology of GNB infections varies based on adherence to infection prevention and control policies and the patient's demographic and clinical characteristics.…”

“…The current study nding is consistent with Chang and others in the emergency ICU at Sichuan Provincial People's Hospital, China. Generally, patients with chronic diseases, such as coronary and respiratory diseases, have prolonged mechanical ventilation time, length of stay, and suppressed immunity making the patient more vulnerable to infection (39).…”

Association between multidrug-resistant bacteria and outcomes in intensive care unit patients: a non-interventional study

“…Escherichia coli, Enterobacter spp., and Proteus mirabilis exhibited mortality rates of 42.9, 42.1, and 41.7%, respectively. Other authors mention higher mortality rates associated with MDR and Gram-negative bacteria ( 24 , 25 ). It is crucial to reiterate that macrolide treatment exhibited a protective effect against in-hospital mortality, as evidenced by an odds ratio (OR) less than 1.…”