Abstract
The incidence of infections caused by multidrug resistant bacteria is increasing worldwide. The frequent misuse of antibiotic drug has greatly contributed to worldwide dissemination of antibiotics resistance. Multi-drug resistance in Gram-negative and Gram-positive bacteria causes a wide range of infections, particularly in the Intensive Care Unit (ICU) settings leading to an increased impact on morbidity, mortality and costs. This study was undertaken to determine the prevalence of multidrug resistant of bacterial isolates in patients admitted in ICU of university hospital of Constantine. We analyzed a 5-year period, from 2011 to 2015. Over five years period, 7472 clinical samples were collected in the Clinical Microbiology Laboratory of Benbadis University Hospital in Constantine. Identification of the isolates was performed by API automated systems (bioMerieux, Marcy l’Etoile, France) and automate microscan walkaway 96 (Siemens). Antibiotic resistance was determined by the Clinical and Laboratory Standards Institute (CLSI) disk diffusion test on Mueller-Hinton Agar. Multidrug-resistant isolates included in this study were methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Enterobactericeae that produce extended-spectrum beta lactamases and/or carbapenemases, multidrug-resistant Acinetobacter baumannii and multidrug-resistant Pseudomonas aeruginosa. A total of 3528 isolates were collected from various specimens such as blood (47.05%).The Staphylococcus sp, Klebsiella sp, Acinetobacter sp, P. aeruginosa and E. coli are the most common isolates recovered from clinical specimens in ICU (26.3, 18.7, 14.3, 11.9 and 9.2% respectively). MRSA strains constituted over 65% of all S. aureus isolates and 30.3% of E. faecium were found to be vancomycin resistant. Extended spectrum β-lactmase producers were expressed in 53.2% and 50.6 from K. pneumoniae and E. coli. Carbapenem resistance among K. pneumoniae improved slightly from 2.89 to 4.21%. A. baumannii isolates exhibited extremely high levels of resistance to all antibiotics except colistin (100% sensitive). In addition, 80.4% of A. baumannii isolates were found to be resistant to imipenem. Imipenem resistant P. aeruginosa isolates showed 36.4%. Key words: Multi-drug resistant bacteria, Intensive care unit, Gram negative bacteria, Gram positive bacteria.
Highlights
The increase and spread of multidrug resistant
MDR bacteria can cause a wide range of infections, including bacteremia, pneumonia, urinary tract infection, peritonitis etc., which can lead to substantial morbidity and mortality, in the Intensive Care Unit (ICU) settings (Chen et al, 2016)
Infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) may be more frequent in the ICU than in general wards (Fridkin and Gaynes, 1999) and its resistance is conferred by the acquisition of one of several staphylococcal cassette chromosome mec elements that carry a gene that encodes a penicillin-binding protein (PBP2a) with low affinity for β-lactam antibiotics (Katayama et al, 2000)
Summary
The increase and spread of multidrug resistant MDR bacteria can cause a wide range of infections, including bacteremia, pneumonia, urinary tract infection, peritonitis etc., which can lead to substantial morbidity and mortality, in the ICU settings (Chen et al., 2016). The risk of acquiring MDR bacteria in the ICU is increased by severity of illness, length of stay, use of intravascular devices, exposure of ICU patients to invasive therapeutic procedures like endotracheal intubation, the intensity of exposure to infected patients and the frequent misuse of antibiotic drug (Khan et al., 2014; Royer et al 2015; Wroblewska et al, 2006).
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