Abstract
BackgroundThe intensive care unit (ICU) admits critically ill patients requiring advanced airway, respiratory, cardiac and renal support. Despite the highly-specialized interventions, the mortality and morbidity is still high due to a number of reasons including nosocomial infections, which are the most likely complications in hospitalized patients with the rates being highest among ICU patients.MethodsIn this cross-sectional study of 111 adult patients admitted to 2 of the ICUs in Uganda, we set out to describe the commonest bacterial infections, their antimicrobial susceptibility patterns and factors associated with development of a nosocomial infection.ResultsKlebsiella pneumoniae (30%), Acinetobacter species (22%) and Staphylococcus aureus (14%) were the most frequently isolated bacteria. The prevalence of multidrug resistant bacterial species was 58%; 50% Escherichia coli and 33.3% Klebsiella pneumoniae were extended spectrum beta lactamase or AmpC beta lactamase producers and 9.1% Acinetobacter species were extensive drug resistant. Imipenem was the antibiotic with the highest susceptibility rates across most bacterial species. Institution of ventilator support (P 0.003) and severe traumatic brain injury (P 0.035) were highly associated with the development of nosocomial infections.ConclusionDue to the high prevalence of multi drug resistant (MDR) and extensive drug resistant bacterial species, there is a need for development of strong policies on antibiotic stewardship, antimicrobial surveillance and infection control to help guide empirical antibiotic therapy and prevent the spread of MDR bacteria and antibiotic drug resistance.
Highlights
The intensive care unit (ICU) admits critically ill patients requiring advanced airway, respiratory, cardiac and renal support
In Canada, Zhanel et al, between 1 September 2005 and 30 June 2006, collected 4180 isolates recovered from clinical specimens from patients in 19 intensive care units and found Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Haemophilus influenzae, Enterococcus species, Streptococcus pneumoniae, and Klebsiella pneumoniae were the most common isolates [11]
82 patients were already receiving antibiotics. 72% were receiving cephalosporins alone, 11% were on penicillins alone, 5% on carbapenems alone, 5% on a fluoroquinolone alone, 2% on cephalosporin and metronidazole combined, 2% on macrolides and quinolone, and the rest distributed between macrolides, metronidazole and a combination of a carbapenem and metronidazole
Summary
The intensive care unit (ICU) admits critically ill patients requiring advanced airway, respiratory, cardiac and renal support. Despite the highly-specialized interventions, the mortality and morbidity is still high due to a number of reasons including nosocomial infections, which are the most likely complications in hospitalized patients with the rates being highest among ICU patients. Nosocomial infections (NIs) are defined as hospital acquired infection developing at least 48–72 h after admission [1]. They are the commonest complications affecting hospitalized patients but are more frequent in intensive care units [2] where outbreaks often originate [3]. A World Health Organization (WHO) systematic review and meta-analysis showed health-careassociated infection density in adult intensive-care units in developing countries was 47.9 per 1000 patient-days (95% CI 36.7–59.1), at least three times as high as densities reported from the USA. In Canada, Zhanel et al, between 1 September 2005 and 30 June 2006, collected 4180 isolates recovered from clinical specimens from patients in 19 intensive care units and found Staphylococcus aureus (methicillin sensitive S. aureus and methicillin resistant S. aureus, MRSA), Escherichia coli, Pseudomonas aeruginosa, Haemophilus influenzae, Enterococcus species, Streptococcus pneumoniae, and Klebsiella pneumoniae were the most common isolates [11]
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