Correlates of drug resistance comparison between hospital-acquired and community-acquired infections: A multicentre study in Lebanon

Abstract

Introduction Hospitals are a threatening environment because of a variable number of virulent pathogens that are brought to it from the community through admitted patients. The prevalence of hospital-acquired infections is generally higher in developing countries of limited resources. Appropriate antimicrobial therapy is important for treatment of patients with severe infections. Factors related to the host may contribute to an increase in mortality associated with resistant organisms because the severity of the underlying disease may be synergistic with infection with resistant organisms. Patients from socioeconomically deprived areas develop morbidity a decade before people in affluent areas due to the high burden of infectious diseases. Due to the availability of antibiotics in community pharmacies without physician prescription, our country is witnessing an increase in the resistance of a number of bacterial infections to common antimicrobial agents. To our knowledge, no study has ever identified characteristics of bacteria comparing community and hospital settings in Lebanon. Our objective was primarily to determine the patients’ risk factors of infection with multidrug resistance in accordance with the type of infections and to examine the comorbidities as possible determinants of resistant infections. Methods This was a multicenter study from five private hospitals. These patients were selected according to positive cultures from the microbiology laboratory in each hospital. Each patient was only included once. Two hundred fifty-eight patients were enrolled in our study. Data were collected through a standardized sheet of patient identification. “Hospital-acquired infection (HAI)” was defined as a localized or systemic condition that resulted from an adverse reaction due to the presence of infectious agents, which occurred 48 hours or more after hospital admission and was not incubating at the time of admission. “Community-acquired infection (CAI)” were defined as an infection detected within 48 hours of hospital admitted patients. Statistical evaluation was conducted through bivariate and multivariable risk factor analyses, with the presence of infection with resistant bacteria as dependent variable. Furthermore, we did stratification according to (HAI) versus (CAI). Data was entered and analysed, using Statistical Package for Social Sciences (SPSS) version 24 software. In all analysis, a P-value Results Eighty-four patients (32.6%) had resistant bacteria and 174 (67.4%) were infected with sensitive bacteria to their usual antibiotics. Patients having resistant bacteria were older than patients with sensitive bacteria (ORa = 2.82 CI [1.146; 6.945]). As comorbidities, these patients had impaired immune system (ORa = 2.14; CI [1.66; 3.940]). Regarding patients who had (HAI), 54 (46.6%) had resistant bacteria and 62 (53.4%) had sensitive bacteria and a significant relationship was shown with patients having diabetes mellitus (ORa = 3.371; CI [1.307; 8.696]). Among patients with (CAI), 112 (78.9%) had sensitive bacteria while 30(21.1%) had resistant bacteria and the factor that had a significant relationship was patients having chronic renal failure (ORa = 2.721; CI [1.027; 7.025]). Conclusion Physicians should be aware of patients’ comorbidities to properly guide initial therapy and should identify patients at risk of bacterial resistance from the onset of infection.