Abstract
IntroductionMultidrug-resistant organisms (MDROs) have been a major concern in King Saud Medical City (KSMC) recently. The number of cases with colistin resistance was growing rapidly in the first half of 2016, challenging the infection control practices and mandating a thorough outbreak investigation. The objective of this study was to determine the extent of the outbreak, identify potential risk factors and prevent further increase in the rates of MDROs.MethodsReviewing the medical records of the 22 admitted cases with colistin resistance using an abstraction form composed of demographical data, comorbidities, details of current admissions, and procedures. Also, tracking patients' movements in the hospital, reviewing all cultures isolates, and reviewing the surveillance and infection control strategies.ResultsMean age was 49.71±17.824 (20-79 years), 90.9% were males, 63.6% cases admitted under medical unit. The average duration of stay in the ED was 1.23 day. Over 2/3 had hypertension and diabetes mellitus. Majority of patients staying between 20-40 days in the hospital & the average number of days until developing colistin resistance was 44.18. Resistance was solely related to two organisms that were Acinetobacter baumanni (59.1%) and Klebsiella pneumoniae (40. 9%). Ventilators and folly's catheters were equally (95.5%) used by 21 patients. The most common site of infection was respiratory (41.3%), of which most were sputum samples. Resistance of over 75% is recorded by antibiotics like tazocin, ciprofloxacin, imepenen and oxacillin.ConclusionThe uncontrolled use of antibiotics, prolonged stay in the Intensive Care Unit (ICU), frequent uses of different devices, are the potential risk factors of developing colistin resistance.
Highlights
Similar to other regions in the world, anti-microbial resistance (AMR) is a severe and worsening problem on the Arabian Peninsula
Two cases were referred from other hospitals, and the remaining 20 (91%) cases were admitted through emergency department (ED)
There are obvious clear factors which played a critical role in augmenting the problem including prolonged hospital stays in Intensive Care Unit (ICU), frequent movements of unclear necessity, comorbidities, unregulated use of antimicrobials, and the need for procedures or instrumentation necessary to support patients
Summary
Similar to other regions in the world, anti-microbial resistance (AMR) is a severe and worsening problem on the Arabian Peninsula. The scope of AMR in this region has not been well defined due to the lack of systematic surveillance at the national level and easy accessibility to over-the-counter drugs [1, 2]. The unregulated use of the last resort drugs like colistin without adequate cause has played a major role. There has been increased rate of colistin resistance [3,4,5,6]
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