Comparative analysis of colistin minimum inhibitory concentration detection methods and risk factors for multidrug-resistant organism in intensive care units and high dependancy units: Implications for infection control practices

Objectives The objective of this study was to screen patients in the intensive care unit (ICU) for multidrug-resistant organisms (MDROs) and analyze the most common risk factors for infection. The aim was to provide a clinical reference for improving the prognosis of these patients through enhanced antimicrobial stewardship (AMS) measures and infection control practices. Material and Methods This study was conducted over a 2-year period (June 2021-June 2023) in the ICUs, high dependency units (HDUs), and other wards of a tertiary care hospital. All ICU patients were screened for MDRO colonization, and those with risk factors were analyzed. The inclusion criteria included patients aged 18 years or older with complete medical records who received treatment in the ICU, HDUs, and other wards. Results The study identified 105 MDRO cases, with the most common organisms being Klebsiella pneumoniae (30 cases), Acinetobacter baumanii (23 cases), and Pseudomonas aeruginosa (17 cases). Carbapenem resistance was highest in Klebsiella pneumoniai (28 cases), followed by E. coli (26 cases), Acinetobacter baumanii (19 cases), and Pseudomonas aeruginosa (11 cases). Colistin resistance was most frequently observed in Klebsiella pneumoniae (51 cases). The most common wards with MDRO cases were the emergency intensive care unit (EICU), neuroscience intensive care unit (NSICU), and one of the three HDUs, and the most frequent specimens were tracheal, urine, and pus samples. Risk factors included diabetes (40%), immune immune-compromised state (30%), use of broad-spectrum antibiotics (60%), malnutrition (10%), malignancies (20%), hemodialysis (5%), and recent surgery (70%). Several patients exhibited overlapping high-risk factors, indicating a higher cumulative risk for adverse health outcomes. Conclusion The study highlights the critical importance of stringent AMS and infection prevention and control (IPC) practices in ICUs to combat MDRO infections. Effective implementation of these measures can significantly reduce the spread of MDROs and improve patient outcomes. Enhancing training programs, improving technological infrastructure, developing standardized data protocols, and conducting community awareness campaigns are essential steps to address the identified challenges. Ensuring regular monitoring and evaluation will further enhance the effectiveness of these interventions.

Chicken farms are nowadays regarded as reservoirs of multi-drug resistance. Studies have shown that resistant organisms can be readily transferred from animals to their surrounding ecosystem. The aim of this study is to determine if any link exists between the prevalence of multi-drug resistance in chicken farms and their surrounding environment. In May-2017, 200 fecal swabs were collected from a chicken farm in Lebanon. Fecal samples from six workers and 41 environmental samples surrounding the farm were also taken. Three different selective media were used for the screening of multi-drug resistant and colistin resistant organisms. MALDI-TOF was used for bacterial identification. Double disk synergy test and ampC disk test were used for the screening of ESBL and ampC producers respectively. Furthermore, RT-PCR was performed for the detection of beta lactamase and mcr colistin resistance genes. In chicken, 315 E.coli strains were isolated: 53% were ESBL/ampC co-producers, 27% ampC and 42.5% mcr-1 positive isolates. Furthermore, 29 K.pneumoniae harboring mcr-1 were also isolated. In workers, ESBL producing E.coli were detected in 4/6 workers whereas mcr-1 carrying E.coli were detected in all workers. In the environment, ESBLs and mcr-1 positives were detected in 95% and 7% of the samples respectively. RT-PCR revealed the detection of B-lactamase genes in all samples at different rates. This study showed a relatively high prevalence of ESBL and mcr-1 positive isolates in chicken and their environment. MLST is in progress to determine if any link exists between multi-drug resistant organisms in these ecosystems investigated.

What's trending in the infection prevention and control literature? From HIS 2012 to HIS 2014, and beyond

Few data are available on incidence of multidrug-resistant organism (MDRO) colonization and infections in mechanically ventilated patients, particularly during the COVID-19 pandemic. We retrospectively evaluated all patients admitted to the COVID-19 intensive care unit (ICU) of Hub Hospital in Milan, Italy, during October 2020‒May 2021. Microbiologic surveillance was standardized with active screening at admission and weekly during ICU stay. Of 435 patients, 88 (20.2%) had MDROs isolated ≤48 h after admission. Of the remaining patients, MDRO colonization was diagnosed in 173 (51.2%), MDRO infections in 95 (28.1%), and non-MDRO infections in 212 (62.7%). Non-MDRO infections occurred earlier than MDRO infections (6 days vs. 10 days; p<0.001). Previous exposure to antimicrobial drugs within the ICU was higher in MDRO patients than in non-MDRO patients (116/197 [58.9%] vs. 18/140 [12.9%]; p<0.001). Our findings might serve as warnings for future respiratory viral pandemics and call for increased measures of antimicrobial stewardship and infection control.

Infection with multi-drug resistant organisms (MDROs) has emerged as a global problem in medical institutions. Overuse of antibiotics is the main cause of drug resistance. Notably, the incidence of infection with MDROs increases in patients with limb fractures who have undergone invasive surgery. The present study aimed to analyze the risk factors for postoperative MDROs infection in a cohort of patients with limb fractures. A retrospective study was performed on the data of patients with fractures between January 2020 and August 2022. Postoperative surgical site infection occurred in 114 patients in total, of which 47 were infected with MDROs. Univariate logistic regression analysis and multivariate binary logistic regression were used to confirm the associations between independent risk factors and MDRO infection. A total of 155 bacteria were collected from patients with MDROs infection and patients with non-MDROs infection, of which 66.5% were gram-positive bacteria and 33.5% were gram-negative. Staphylococcus aureus accounted for 26.5% of the 155 pathogens. MDROs, such as methicillin-resistant S. aureus and extended-spectrum β-lactamases-positive gram-negative bacillus, were detected after antibiotic treatment. Univariate analysis indicated that the number of antibiotics administered, being bedridden, repeat infection, operative time and repeated operation were different in the two groups. In addition, univariate logistic analysis indicated that being bedridden (OR, 3.98; P=0.001), administration of >2 antibiotics (OR, 2.42; P=0.026), an operative time of >3 h (OR, 3.37; P=0.003), repeated infection (OR, 3.08; P=0.009) and repetition of procedures (OR, 2.25; P=0.039) were individual risk factors for MDRO infection. Multivariate analysis showed that being bedridden (OR, 2.66; P=0.037), repeated infection (OR, 4.00; P=0.005) and an operative time of >3 h (OR, 2.28; P=0.023) were risk factors of MDRO infection. In conclusion, constrained antibiotic use, shortened operative time and increased activity duration can effectively prevent surgical-site infection with MDROs in patients with fractures.

Postoperative gastric cancer patients requiring intensive care unit (ICU) management are vulnerable to healthcare-associated infections, including multidrug-resistant organism (MDRO) infections. Evidence defining ICU-specific clinical risk factors in this population remains limited. This retrospective cohort study enrolled consecutive adult patients with pathologically confirmed gastric cancer who underwent gastrectomy and required postoperative ICU care between June 2022 and June 2025. MDRO infection was defined by concordant clinical infection features and microbiological confirmation with isolates demonstrating acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Demographic characteristics, comorbidities, perioperative variables, ICU therapies, prior antibiotic exposure within 90 days, and admission laboratory indices were collected. Between-group comparisons and univariate and multivariable logistic regression analyses were performed. Of the 216 included patients, 51 were classified into the MDRO infection group and 165 into the non-MDRO infection group. Pulmonary infection was the most frequent clinical type, followed by intra-abdominal/surgical site, bloodstream, and urinary tract infections. Resistant Gram-negative organisms predominated, led by extended-spectrum β-lactamase–producing Enterobacterales, carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Enterobacterales, and carbapenem-resistant Pseudomonas aeruginosa. In multivariable analysis, older age (OR 1.04 per year), diabetes mellitus (OR 1.86), intraoperative blood loss (OR 1.49 per 100 mL), anastomotic leakage (OR 3.06), mechanical ventilation (OR 1.79), higher Acute Physiology and Chronic Health Evaluation II score (OR 1.12 per point), and prior antibiotic exposure within 90 days (OR 2.16) were independently associated with MDRO infection, whereas higher admission albumin was inversely associated (OR 0.92 per g/L). Sensitivity analyses yielded consistent results. In postoperative gastric cancer ICU patients, ICU-acquired MDRO infections were common and predominantly Gram-negative, with respiratory and intra-abdominal foci. A combined profile of baseline vulnerability, operative burden, ICU severity, and recent antibiotic exposure was associated with MDRO infection risk, supporting risk stratification and targeted preventive and stewardship strategies. Not applicable.

The prevalence of patients with infections caused by multidrug-resistant organisms (MDROs) has dramatically increased across health care systems. MDROs represent a significant public health issue,1 and outpatient dialysis centers are increasingly being called upon to accept and care for these patients. Hemodialysis facilities serve a critical role in communities, caring for some of the most complex and vulnerable patients in the health care system. The efficient operation of these facilities is essential for the functioning of acute care, post–acute care, and long-term care networks. As medical leaders of the major dialysis provider organizations, we want to share our perspective on the effect and unique challenges of caring for these patients who present differential burden for dialysis facilities. MDROs are characterized by resistance to one or more classes of antimicrobials.1 They are especially problematic because of their hardiness and endurance in the environment, high transmissibility, difficulty with detection, frequent asymptomatic colonization, and significant associated morbidity and mortality.1 Once present, they are challenging and costly to eradicate,2 increasing the risk of spread to other patients through environmental and staff contamination. More than 550,000 patients in the United States receive maintenance dialysis for kidney failure; the majority are treated in communal settings. Most are chronically ill and functionally immunocompromised with multiple comorbidities. They are frequent utilizers of health care facilities and often have in-dwelling medical devices. Recent data indicate that over 50% of patients with kidney failure receive antibiotics annually.3 These factors render patients on dialysis uniquely susceptible to colonization and infection with MDROs, and bacterial colonization and infection rates in patients receiving dialysis greatly exceed those of other at-risk populations.4–7 Data on prevalence and incidence of MDROs in outpatient dialysis facilities are limited. A meta-analysis from 2014 including 23 reports revealed a 6.3% pooled prevalence for colonization of patients receiving dialysis with vancomycin-resistant enterococcus.5 However, rates varied across studies from <1% to 30%.4–7 A prospective cohort study in patients on dialysis in which serial surveillance cultures were obtained demonstrated that 28% of patients were colonized with one or more MDRO.4 General recommendations for preventing the emergence and spread of these organisms are presented in Table 1.9 Specific measures for management and treatment of infected patients vary by organism but may include isolation or cohorting, contact investigation and reporting, contact precautions, staff training and education, routine/active surveillance, dedicated staff, unique personal protective equipment requirements, augmented cleaning (Environmental Protection Agency list P or K), and extra disinfection of equipment (Table 1).1,2,9,10 The Centers for Disease Control and Prevention has not published guidelines for the management of these patients in outpatient dialysis facilities. While it is common practice to extrapolate the same standards designed for acute care settings, these current recommendations are not uniformly transferable. Table 1 - Select recommendations for prevention and control of multidrug-resistant organism control measures Control Measure Type Administrative 1. Implementing system changes to ensure prompt and effective communication to identify patients known to be infected or colonized with MDROs 2. Providing the necessary number and appropriate placement of hand washing sinks and alcohol-containing hand rub dispensers in the facility 3. Maintaining staffing levels appropriate to the intensity of care required 4. Enforcing adherence to recommended infection control practices for MDRO control 5. Obtain expert consultation from persons with experience in infection control and the epidemiology of MDRO Education 1. Facility-wide, unit-targeted, and informal educational interventions to encourage a behavior change through improved understanding of the problem of targeted MDRO 2. Provide education and training on risks and prevention of MDRO transmission at new-hire orientation and periodically Judicial antimicrobial use 1. Review local susceptibility patterns and include appropriate antimicrobial agents on formulary to foster appropriate use 2. Implement systems and process to review antibiotic use and distribute reports to providers Surveillance 1. Establish systems to ensure that clinical microbiology laboratories promptly notify facility when novel resistance pattern for that facility is identified 2. In an outbreak setting, develop and implement protocols to obtain active surveillance cultures from patients in populations at risk Infection control precautions 1. Follow standard precautions in all health care settings 2. Implement contact precautions for all patients known to be colonized/infected with target MDRO 3. When active surveillance cultures are obtained in outbreak setting, implement contact precautions until the culture is reported negative for the target MDRO 4. Use single-patient rooms if available for patients with MDRO 5. When single-patient rooms are not available, cohort patients with the same MDRO in the same patient care area 6. No recommendation can be made regarding when to discontinue contact precautions Environmental measures 1. Follow recommended cleaning, disinfection, and sterilization guidelines for maintaining patient care areas and equipment based on the MDRO 2. Dedicate non-critical medical items to use on individual patients known to be infected or colonized with an MDRO Decolonization Not recommended routinely Siegel et al.8 MDRO, multidrug-resistant organism. These recommendations are difficult to implement in an outpatient setting and often require substantial additional human and material resources. The literature suggests that many dialysis facilities are challenged with ensuring infection control and, consequently,11 that transmission of MDROs does occur in the outpatient dialysis setting. A prospective cohort study in an outpatient dialysis facility where colonization with MDROs was present demonstrated acquisition of one or more MDRO in 40% of patients who were negative at enrollment.4 Current characteristics of the dialysis facilities contribute to these challenges including staffing challenges, capacity issues, as well as shared treatment space, staff, equipment, bathrooms, and waiting areas. In addition, proximity to many other patients and frequent and prolonged contact between health care workers and patients create substantial opportunity for spread of MDROs. Standard precautions used in dialysis facilities do not reliably halt MDRO transmission in all circumstances.10 Requiring a level of care that approaches that of acute care settings without the necessary infrastructure negates the efficiencies that allow hemodialysis units to operate at scale. The recommended infection control interventions, physical environment changes, and pharmaceutical costs to care for patients with MDROs can be prohibitive and disruptive for dialysis facilities.1,2 Management of patients with MDRO may necessitate altering patient and staff scheduling, limiting or eliminating the use of shared equipment and space, and at times even closure or suspension of new admissions.2,12 These additional precautions are costly and impose additional staff demands, further exacerbating unprecedented labor shortages, supply cost inflation, and caregiver burnout. Unlike acute care settings, it is not possible to provide one-on-one nursing for these patients in an outpatient setting. For many of these organisms, given the difficulties with eradication and challenges of identifying the organisms by standard laboratory techniques, current guidance suggests that contact precautions are continued indefinitely.9 Isolation of colonized or infected individuals can create unwarranted fear, stigma, and psychological burden for patients and their families. There are often additional laboratory costs created by the specific culture methods required for MDRO surveillance. If the patients require treatment of an MDRO, the options are often limited, costly, and frequently associated with significant side effects and/or require extra monitoring. Dialysis facilities do not have on-site infectious disease consultants, infection preventionists, or laboratory and pharmacy resources to assist with these added demands. As a result of these complex logistic issues, many dialysis facilities, facing untenable operational trade-offs, are unable to accept patients with MDRO infection or colonization. The current system was structured to deliver efficient treatment of large numbers of generally stable patients with kidney failure; however, it is not equipped or staffed to care for patients requiring prolonged isolation treatments. Alternative solutions to accommodate the patient on dialysis with an MDRO include independent or staff-assisted home dialysis or dialysis in skilled nursing facilities; however, costs and logistic barriers may not permit these options. The extensive comorbidities common to patients with MDRO limit the number of patients suitable for home dialysis. Staffing shortages limit the ability of individual skilled nursing facilities to provide dialysis care for small numbers of such patients. Additional funding to compensate for the increased costs of care and exemption from hospital-based guidelines, coupled with the development of guidelines specific to outpatient dialysis facilities, would likely increase the willingness and ability of facilities to care for these patients. Research must be dedicated to understanding the most cost-effective means of mitigating and managing MDROs in outpatient dialysis facilities and exploring novel options for the care of these patients. A better understanding of the transmission dynamics, the benefits of barrier measures, separation of patients with MDRO, and sanitization of personnel and equipment is needed to facilitate the care of these patients. Developing and testing innovative strategies to limit risk of MDROs and their spread requires collaboration between dialysis providers, physicians, acute and post-acute settings, long-term residential facilities, transport providers, and payers. The increasing adoption of at-risk financial government and commercial payor programs opens opportunities for offsetting the increased expenditures to fund innovation and pilot infection control interventions. Initiatives, such as KidneyX, can spur innovation in these areas. Partnership with the local ESKD networks and the American Society of Nephrology, Nephrologists Transforming Dialysis Safety, may yield additional expertise and solutions. In addition, collaboration with state and local health departments and the Centers for Disease Control and Prevention may bring additional resources, and often, these are reportable infections. Dialysis providers look forward to participating in policy discussions and research efforts that consider the need to align MDRO vigilance and interventions across a broad spectrum of care.

BACKGROUNDColonization with multidrug-resistant organisms (MDROs) is frequently observed in critically ill patients with liver cirrhosis admitted to intensive care units (ICUs). However, whether colonization directly leads to infections or adversely impacts clinical outcomes remains unclear. Clarifying this relationship may help determine the prognostic significance of colonization in these patients.AIMTo evaluate the clinical relevance of MDRO colonization and infection at ICU admission in patients with cirrhosis.METHODSThis retrospective single-center cohort study included 107 ICU admissions of patients with liver cirrhosis at a tertiary care center (2018-2024). Colonization was assessed by rectal and nasal/pharyngeal swabs within 48 hours of ICU admission. Outcomes analyzed included MDRO infection during ICU stay, concordance between colonizing and infecting strains, organ support requirements, and 28-day transplant free survival. Multivariable logistic regression and Kaplan-Meier analyses were used to evaluate predictors of infection and mortality.RESULTSNearly one-third (29.9%) of patients were colonized with MDROs on admission, more commonly in the acute-on-chronic liver failure phenotype than those with acute decompensation (34.5 vs 10.0%, P = 0.033). Although infections were established in the majority (85%) of cases, of which 17.6% due to MDROs, colonization alone did not independently predict these infections [odds ratio (OR) = 2.18, P = 0.383] nor influenced short-term mortality (OR = 1.14, P = 0.813). However, once MDRO infection occurred, an 82% concordance was observed between colonizing and infecting strains. MDRO infections, unlike colonization, significantly increased the need for organ-support interventions, including mechanical ventilation and vasopressor therapy and prolonged ICU stays. Only severity of organ dysfunction, quantified by the Sequential Organ Failure Assessment score, independently predicted 28-day mortality (OR = 1.38, P = 0.024).CONCLUSIONMDRO colonization at ICU admission is frequent among critically ill patients with cirrhosis, particularly those with acute-on-chronic liver failure. While colonization alone does not predict infection or early mortality, its clinical value emerges in guiding empirical antibiotic treatment once infection is suspected. Ultimately, short-term survival appears to be more strongly influenced by the severity of organ failure than by either MDRO colonization or infection.

BackgroundThe systematic collection of valid data related to hospital-acquired infections (HAIs) is considered effective for nosocomial infection prevention and control programs. New strategies to reduce HAIs have recently fueled the adoption of real-time automatic nosocomial infection surveillance systems (RT-NISSs). Although RT-NISSs have been implemented in some hospitals for several years, the effect of RT-NISS on HAI prevention and control needs to be further explored.MethodsA retrospective, descriptive analysis of inpatients from January 2017 to December 2019 was performed. We collected hospital-acquired infection (HAI) cases and multidrug resistant organism (MDRO) infection cases by traditional surveillance in period 1 (from January 2017 to December 2017), and these cases were collected in period 2 (from January 2018 to December 2018) and period 3 (from January 2019 to December 2019) using a real-time nosocomial infection surveillance system (RT-NISS). The accuracy of MDRO infection surveillance results over the 3 periods was examined. The trends of antibiotic utilization rates and pathogen culture rates in periods 2 and 3 were also analysed.ResultsA total of 114,647 inpatients, including 2242 HAI cases, were analysed. The incidence of HAIs in period 2 was significantly greater than that in period 1 (2.28% vs. 1.48%, χ2 = 61.963, p < 0.001) and period 3 (2.28% vs. 2.05%, χ2 = 4.767, p = 0.029). The incidence of five HAI sites, including respiratory infection, urinary tract infection (UTI), surgical site infection (SSI), bloodstream infection (BSI) and skin and soft tissue infection, was significantly greater in period 2 compared with period 1 (both p < 0.05) but was not significantly different from that in period 3. The incidence of hospital-acquired MDRO infections in period 3 was lower than that in period 2. The identification of MDRO infection cases using the RT-NISS achieved a high level of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV), especially in period 3 (Se = 100%, Sp = 100%, PPV = 100% and NPV = 100%).ConclusionThe adoption of a RT-NISS to adequately and accurately collect HAI cases is useful to prevent and control HAIs. Furthermore, RT-NISSs improve accuracy in MDRO infection case reporting, which can timely and accurately guide and supervise clinicians in implementing MDRO infection prevention and control measures.

ObjectiveTo understand the infection status and disease spectrum distribution of patients with hospital-acquired Multidrug-resistant Organism (MDRO) Infections in an intensive care unit (ICU) before, during, and after the Coronavirus Disease 2019 (COVID-19) Pandemic, and provide a basis for the prevention and control of hospital-acquired MDRO infections.MethodsData from the Second People’s Hospital of Fuyang City’s ICU was analyzed from three periods: pre-COVID-19 (January 1, 2018-December 8, 2019), during COVID-19 (December 9, 2019-December 7, 2022), and post-COVID-19 (December 8, 2022-December 31, 2023). The study compares the disease spectrum of MDRO infections patients across these periods.ResultsThe incidence density of hospital-acquired MDRO infections showed significant variation over the six-year period, with the highest density in the post-COVID-19 period (43.98 per 1,000 ICU days) and the lowest during the COVID-19 period (21.96 per 1,000 ICU days). The mortality rate associated with MDRO infections was minimized during the COVID-19 pandemic (2.70 per 1,000 ICU days) and rebounded in the post-COVID-19 period (10.66 per 1,000 ICU days). The infection rate of Acinetobacter baumannii (A. baumannii) increased in the post-COVID-19 group compared to the pre-COVID-19 and during-COVID-19 groups (χ2 = 8.82, p = 0.012). Respiratory diseases consistently ranked first pre-, during, and post-COVID-19 pandemic. The proportion of nervous system diseases in the post-COVID-19 group was lower than in the pre-COVID-19 and during COVID-19 groups (p < 0.05), while the proportions of respiratory diseases and acute abdomen were higher than in the pre-COVID-19 and during-COVID-19 groups (p < 0.05). Among ICU MDRO patient death cases, the proportion of respiratory diseases in the post-COVID-19 group was higher than in the pre-COVID-19 and during-COVID-19 groups (p < 0.05).ConclusionOur data show the mortality rate of hospital-acquired MDRO infections decreased during COVID-19 and increased after restrictions eased. The disease spectrum of MDRO-infected patients is complex and diverse. Standardized, accurate treatment and focused management of respiratory diseases are essential, along with strengthened infection prevention measures.

Introduction: As Antimicrobial Resistance (AMR) continues to pose a global health crisis, rapid and accurate antimicrobial susceptibility testing is crucial. In Intensive Care Unit (ICU) patients with sepsis, the 48-hour delay associated with conventional culture-based reports can be critical. The present study aimed to compare the rapid Colistin NP test with conventional culture techniques as a key strategy to combat antibiotic resistance caused by Multidrug Resistant (MDR) organisms. Aim: To perform a comparative evaluation of three different methods for detecting colistin resistance: Broth Microdilution (BMD), Disc Elution (DE), and rapid colistin NP tests. in Enterobacterales And to determine the Minimum Inhibitory Concentration (MIC) of colistin using the BMD test, to determine the MIC of colistin. Materials and Methods: The present cross-sectional study was conducted over twelve months (January 2023 to December 2023) at SRM Medical College Hospital and Research Centre, Chengalpattu, Tamil Nadu, India. The primary inclusion criteria that was set for the study was that blood specimens from ICU patients testing positive for Gram Negative Bacilli (GNB) were included in the study. The sample size was determined to be 178. Blood samples positive only for GNB belonging to Enterobacterales were taken into consideration. BMD and DE tests were performed to determine the MIC of colistin. Additionally, the rapid colistin NP Test was conducted to assess antibiotic susceptibility.The assessment was conducted directly from BacT/ALERT bottles as well as from bacterial isolates. The blood samples were collected from patients above 18 years of age. Statistical analysis was performed using IBM Statistical Package for Social Sciences (SPSS) software. The Chi-square test was used to assess the correlation between BMD (the gold standard method) and other methods such as DE and the rapid colistin NP Test (from both isolates and BacT/ALERT bottles). A p-value of &lt;0.05 was considered statistically significant. Results: Over the study period, 178 GNB isolates were identified. Of these, 151/178 (84.8%) were found to be colistinsensitive by BMD and DE tests. Using the rapid colistin NP Test, 153/178 (85.9%) isolates from bacterial cultures and 154/178 (86.5%) from BacT/ALERT bottles were identified as colistin-sensitive and resistant, respectively. The sensitivity and specificity of the rapid colistin NP Test were 92.5% and 100% for bacterial isolates, and 88.9% and 100% for BacT/ALERT bottles, respectively. Conclusion: The present study demonstrates that the rapid colistin NP test is an effective and reliable method for the early detection of colistin resistance in GNB within the enterobacterales group. The test showed high sensitivity and specificity, offering rapid results that can significantly aid clinical decision-making. Its implementation can facilitate timely initiation of appropriate antimicrobial therapy, helping to curb the spread of resistant strains and improve patient outcomes. These findings support the routine use of the rapid colistin NP Test in clinical microbiology laboratories for the prompt identification of colistin-resistant pathogens.

Objective To investigate the clinical situation of multidrug-resistant organism(MDRO) infections in Heshan people’s hospital so as to provide corresponding prevention and control measures. Methods Retrospective investigation was used to investigate the status and clinical distribution characteristics of 1 587 cases of MDRO infections. Results MDRO infections increased year by year. The infection rate of extended spectrum beta-lactamases (ESBLs)-producing strains was highest and the infection rates of methicillin resistant staphylococcus aureus(MRSA) and multidrug-resistant acinetobacter baumannii (MDR-AB) increased obviously. A total of 66.35% of multi-resistant bacteria was isolated from sputum and urine specimens; The MDRO infected patient were ICU, general surgery department, urologie, neurology department and and health recovery centre. Conclusions MDRO infections in Heshan people’s hospital increased yearly and mainly concentrated on lower respiratory tract and urinary system. The monitoring of drug resistance especially which on high-risk departments and vulnerable patients should be strengthened and the targeted preventive measures should be stressed to curb MDRO infection and spread. Key words: Multidrug-resistant organism; Hospital infection; Clinical distribution; Infection control

BackgroundThis study aimed to elucidate the impact of COVID-19 pandemic on multidrug-resistant organism (MDRO) infection in patients with infected pancreatic necrosis (IPN).MethodsThis post-hoc analysis of a prospective cohort included patients with IPN stratified into three phases: pre-pandemic (2016–2019), pandemic period (2020–2022), and post-pandemic period (2023–2024). Logistic regression and interrupted time-series analysis (ITSA) were employed to identify risk factors and longitudinal trends.ResultsMDRO infection decreased significantly during the pandemic period compared to pre-pandemic levels (44.8% vs 81.1%, P<0.001). There was no significant difference in the incidence of MDRO infection between the pandemic and post-pandemic period (44.1% vs 44.8%, P=0.924). During the pandemic, both prophylactic antimicrobial usage (64.8% vs 85.1%, P<0.001) and ICU stays (median: 6.0 vs 15.0 days, P<0.001) were significantly reduced compared to the pre-pandemic period. Logistic regression identified prophylactic antimicrobial usage (OR 17.28, P<0.001), ICU stays (OR 1.07, P<0.001), and the COVID-19 pandemic (OR 0.21, P<0.001) as independent factors associated with MDRO infection. ITSA revealed a significant decrease in the trend of MDRO infection during the pandemic compared to the pre-pandemic period (P=0.006). An immediate level of MDRO infection increased during the post-pandemic period compared to the pandemic (P=0.040). The similar trend variations were observed in the proportion of prophylactic antimicrobial usage.ConclusionThe COVID-19 pandemic has led to a notable reduction in MDRO infection among IPN patients, likely attributable to stringent infection prevention and control measures which led to reduced prophylactic antimicrobial usage and ICU stays during this period.

Invasive bacterial infections are a leading cause of morbidity and mortality after liver transplant (LT), especially during the first months after LT, and infections due to multi-drug-resistant organisms (MDRO) are increasing in this setting. Most of the infections in patients in intensive care unit arise from the endogenous microflora and, for this reason, pre-LT MDRO rectal colonization is a risk factor for developing MDRO infections in the post-LT. Moreover, the transplanted liver may carry an increased risk of MDRO infections due to organ transportation and preservation, to donor intensive care unit stay and previous antibiotic exposure. To date, little evidence is available about how MDRO pre-LT colonization in donors and recipients should address LT preventive and antibiotic prophylactic strategies, in order to reduce MDRO infections in the post-LT period. The present review provided an extensive overview of the recent literature on these topics, with the aim to offer a comprehensive insight about the epidemiology of MDRO colonization and infections in adult LT recipients, donor-derived MDRO infections, possible surveillance, and prophylactic strategies to reduce post-LT MDRO infections.

Multidrug-resistant organism (MDRO) infections are increasingly prevalent in patients with type 2 diabetic foot ulcers (DFUs), posing substantial challenges to treatment efficacy and clinical outcomes. Understanding the risk factors and epidemiological characteristics of MDRO infections is critical for formulating effective antimicrobial strategies. This single-center retrospective study included 247 patients hospitalized with DFUs between January 2022 and December 2024. Based on microbiological findings, patients were classified into an MDRO group (n = 102) and a non-MDRO group (n = 145). Data on demographics, pathogen distribution, antibiotic resistance profiles, and clinical outcomes were collected. Logistic regression analysis was performed to identify independent risk factors for MDRO infection, and clinical outcomes were compared between the 2 groups. Patients in the MDRO group had a longer duration of diabetes and higher HbA1c levels, along with a significantly greater proportion of Wagner grade ≥ 3 ulcers and peripheral arterial disease (all P < .05). A total of 268 pathogenic strains were isolated, predominantly Gram-negative bacteria (62.3%), with Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii being the most common. The leading MDROs were extended-spectrum β-lactamase-producing E. coli (14.6%) and carbapenem-resistant A. baumannii (11.2%). Multivariate analysis identified Wagner grade ≥ 3 (odds ratio [OR] = 2.31), prior use of broad-spectrum antibiotics (OR = 2.87), and peripheral arterial disease (OR = 1.96) as independent risk factors for MDRO infection. Compared with the non-MDRO group, the MDRO group had significantly higher rates of treatment failure (34.3% vs 18.6%), readmission (21.6% vs 10.2%), and greater antibiotic use, both in number and duration (all P < .05). Higher Wagner grades were also associated with increased rates of MDRO and mixed infections (P < .001). MDRO infections are common among patients with DFUs, with Gram-negative bacteria as the predominant pathogens. Higher Wagner grade, prior antibiotic exposure, and peripheral arterial disease are independent risk factors. MDRO infections impose a greater treatment burden and are linked to poorer prognoses. Early identification of high-risk patients, coupled with optimized infection control and antimicrobial stewardship, is essential to improving clinical outcomes.