Abstract
Bacterial colonization of the skin and mucous membranes of intensive care unit (ICU) patients with virulent organisms such as methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL) producers, and multidrug-resistant Gram-negative bacteria (MDR-GNB) frequently results in life-threatening infections. Universal screening of ICU patients upon admission has been suggested. The aim of the current study was to evaluate the prevalence and pattern of MRSA, ESBL, and MDR-GNB colonization in patients upon admission to an Egyptian medical ICU, along with the related demographic and clinical risk factors. Throat, axillary, and groin swabs were obtained from all study participants in addition to rectal swabs from consenting patients. These swabs were screened for MRSA, ESBL, and MDR-GNB. Of the patients included in the study, 33%, 13%, and 63% were colonized with ESBL, MDR-GNB, and MRSA organisms, respectively. Those suffering from a more severe disease with a simplified acute physiology score II (SAPS II) > 29 demonstrated higher levels of MDR-GNB colonization upon admission, while MDR-GNB or ESBL colonization upon admission was associated with higher ICU mortality. Colonization of ICU patients with superbugs upon admission has an impact on outcome and mortality. In this Egyptian example, colonization rates were higher than in other literature reports, demonstrating the need for routine screening and decolonization, if applicable.
Highlights
Bacterial colonization of the skin and mucous membranes of intensive care unit (ICU) patients with virulent organisms such as methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL) producers, and multidrug-resistant Gramnegative bacteria (MDR-GNB) frequently results in life-threatening infections
74.5% were admitted from the same hospital's ER, 21.9% were referred from same hospital's wards, and 3.6% were referred from other hospitals' ICUs
The current study showed that around one-third of the patients upon ICU admission were colonized with one or more ESBL Gram-negative organisms at one or more of the swabbed sites, with 63% of these ESBL organisms belonging to E. coli species, while around 13% were colonized with one or more of MDR-GNB at one or more of the swabbed sites
Summary
Bacterial colonization of the skin and mucous membranes of intensive care unit (ICU) patients with virulent organisms such as methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL) producers, and multidrug-resistant Gramnegative bacteria (MDR-GNB) frequently results in life-threatening infections. Much interest is directed at the study of groups of micro-organisms that are resistant to multiple antimicrobials (superbugs), which are increasing at an alarming rate in the ICU setting with consequent high morbidity, mortality, and treatment costs [1]. These superbugs include methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase producers (ESBL), multidrug-resistant Gram-negative bacteria (MDR-GNB), and vancomycin-resistant Enterococcus (VRE). ESBL organisms are associated with high morbidity and mortality, especially in ICU patients with multiple comorbidities due to the limited therapeutic choices [5]
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