35 Risk factors for acquisition of multidrug-resistant gram-negative bacteria in a tertiary care hospital in saudi arabia: a case-control study

Abstract

Background The increase in incidence of multidrug-resistant (MDR) organisms, especially gram-negative bacteria, in healthcare facilities is a serious cause of concern worldwide. This study was done at King Abdulaziz Medical City, Jeddah, a tertiary care hospital. The World Health Organization has published a priority pathogens list of antibiotic-resistant bacteria. The priority pathogens have been categorized into three major priorities (i.e., critical, high, and medium). The critical priority pathogens include common gram-negative bacteria (GNB) such as carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant and third-generation cephalosporin-resistant Enterobacteriaceae such as Klebsiella pneumoniae and Escherichia coli. The current study identified risk factors for the acquisition of these MDR gram-negative critical priority pathogens in King Abdulaziz Medical City, Jeddah, to inform strategies for their containment. Methods A case-control study was carried out from January to April 2015, in which 100 patients with healthcare-associated infections (infections arising 48 hours after admission) caused by MDR GNB were compared with two control groups, i.e., 100 patients with healthcare-associated infections caused by non-MDR GNB (not meeting the criteria of MDR) and 100 patients without infection caused by GNB. MDR bacteria were defined as bacteria that were non-susceptible to at least one antibiotic in three or more classes of antibiotics. Data were analyzed using descriptive statistics (frequency and percentage of categorical variables). Multivariate regression analysis was undertaken to identify significant predictors of MDR GNB. Odds ratios (ORs) with 95% CIs were calculated and the level of significance was determined as p Results A total of 388 organisms were isolated during the study period from 332 patients. 56 (14%) patients were infected with more than one organism. Antibiotic therapy (OR 5.50, 95% CI 2.19–13.84; OR 3.98, 95% CI 1.68–9.44), stay in intensive care unit (OR 11.11, 95% CI 4.58–26.93; OR 8.60, 95% CI 3.28–22.57), and having indwelling medical devices (OR 3.02, 95% CI 1.45–6.33; OR 2.43, 95% CI 1.11–5.33) were the significant risk factors in patients infected with MDR GNB compared with each of the other two control groups, respectively. Conclusion The risk factors identified in our study provide guidance for healthcare workers for the prevention and containment of MDR GNB with special emphasis on effective implementation of an antimicrobial stewardship program and enhancing infection control practices in intensive care units.