Bacteria In Intensive Care Unit Research Articles

Prevalence of multi-drug resistant bacteria in intensive care units at Tripoli University Hospital, Tripoli, Libya

ABSTRACT Among hospitalized patients worldwide, infections caused by multidrug-resistant (MDR) bacteria are a major cause of morbidity and mortality. This study aimed to isolate MDR bacteria from five intensive care units (ICUs) at Tripoli University Hospital (TUH). A prospective cross-sectional study was conducted over a seven-month period (September 2022 to March 2023) across five ICUs at TUH. A total of 197 swabs were collected from Patients’, healthcare workers’ and ICUs equipment. Samples collected from patients were nasal swabs, oral cavity swabs, hand swabs, sputum specimens, skin swabs, umbilical venous catheter swabs, and around cannula. Swabs collected from health care workers were nasal swabs, whereas ICUs equipment’s samples were from endotracheal tubes, oxygen masks, and neonatal incubators. Identification and antimicrobial susceptibility test was confirmed by using MicroScan auto SCAN 4 (Beckman Coulter). The most frequent strains were Gram negative bacilli 113 (57.4%) with the predominance of Acinetobacter baumannii 50/113 (44%) followed by Klebsiella pneumoniae 44/113 (40%) and Pseudomonas aeruginosa 6/113 (5.3%). The total Gram positive bacterial strains isolated were 84 (42.6%), coagulase negative Staphylococci 55 (66%) with MDRs (89%) were the most common isolates followed by Staphylococcus aureus 15 (17.8%). Different antibiotics were used against these isolates; Gram- negative isolates showed high resistance rates to ceftazidime, gentamicin, amikacin and ertapenem. A. baumannii were the most frequent MDROs (94%), and the highest resistance rates in Gram-positive strains were observed toward ampicillin, oxacillin, ampicillin/sulbactam and Cefoxitin, representing 90% of total MDR Gram-positive isolates. ESBL and MRS were identified in most of strains. The prevalence of antibiotic resistance was high for both Gram negative and Gram positive isolates. This prevalence requires strict infection prevention and control intervention, continuous monitoring, implementation of effective antibiotic stewardship, immediate, concerted and collaborative action to monitor its prevalence and spread in the hospital.

Gram-Negative Bloodstream Infections in Healthcare: The Relationship Between Antibiotic Resistance, Mortality, and Novel Serological Biomarker.

Bloodstream infections caused by Gram-negative bacteria are highly mortal. In this study, we aimed to investigate the relationship between antimicrobial resistance profile and novel serologicalbiomarkers and mortality in bloodstream infections (BSIs) caused by Gram-negative bacteria in intensive care units (ICUs). 366 Patients diagnosed with healthcare-associated Gram-negative bloodstream infectionin the ICUs of our hospital between February 2015 and December 2021 were included in the study. Demographic variables (age, gender, comorbidities), causative microorganisms and antimicrobial susceptibilities, time to first positive blood culture after hospitalization, length of stay in hospital, surgical procedures, laboratory data (hemograms, C-reactive protein (CRP) levels, albumin), and survival data were collected.Novel serological biomarkers were calculated. Mortality in Gram-negative bloodstream infection was found to be associated with age and novel serological biomarkers, but not with carbapenems and colistin minimum inhibitory concentration (MIC) values. Mortality rates increased with age (p˂0.001). Patients who died had higher C-reactive protein/albumin ratio (CAR) (p<0.001) and neutrophil/lymphocyte ratio (NLR) (p=0.009) and lower prognostic nutritional index (PNI) (p<0.001). The study emphasizes that resistance to colistin and carbapenems is not associated with mortality in BSIs caused by Gram-negative bacteria. Novel serological biomarkers may be useful in predicting mortality. These results support the need for further studies to elucidate the true impact of infections caused by resistant bacteria.

Relationship between nutritional therapy and beneficial bacteria ratio in severe disease

Objective: To evaluate relationship between changes in the beneficial bacteria in intensive care unit (ICU) patients and nutritional therapy type. Methods: Ten patients aged ≥18 years admitted to the ICU between January and December 2020, were included. Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding. The ratio of beneficial bacteria at the first and second bowel movements after each patient's admission was calculated and the patients were classified into the increase or decrease group. Among all patients, five each were in the increase and decrease groups. We investigated patient background, changes in sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) II scores, nutritional doses or methods, and clinical outcomes. Results: No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHE II scores at the time of admission. The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group (4/5 vs. 0/5, P=0.01). Conclusions: An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition. In the future, accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective.

How to Defeat Multidrug-Resistant Bacteria in Intensive Care Units. A Lesson from the COVID-19 Pandemic. Prevention, Reservoirs, and Implications for Clinical Practice.

Background: Intensive care unit (ICU) patients are at high risk of infection due to multiple invasive procedures, malnutrition, or immunosuppression. The rapid increase in infections with multidrug-resistant organisms (MDRO) during the COVID-19 pandemic caused a dilemma, as the rules of the sanitary regime in ICU rooms were strictly adhered to in the prevailing epidemiological situation. The combat to reduce the number of infections and pathogen transmission became a priority for ICU staff. This study aimed to assess whether eliminating environmental reservoirs and implementing improved procedures for patient care and decontamination and washing equipment in the ICU reduced the incidence of infections caused by MDR strains. Material and methods: The study retrospectively analyzed data in the ICU during the COVID-19 pandemic. The samples were collected based on microbiological culture and medical records in the newly opened ICU (10 stations) and hospital wards where COVID-19 patients were hospitalized. Environmental inoculations were performed during the COVID-19 pandemic every 4-6 weeks unless an increase in the incidence of infections caused by MDR strains was observed. Through microbiological analysis, environmental reservoirs of MDR pathogens were identified. The observation time was divided into two periods, before and after the revised procedures. The relationship between isolated strains of Klebsiella pneumoniae NDM from patients and potential reservoirs within the ICU using ERIC-PCR and dice methods was analyzed. Results: An increased frequency of infections and colonization caused by MDRO was observed compared to the preceding years. A total of 23,167 microbiological tests and 6,985 screening tests for CPE and MRSA bacilli were collected. The pathogen spread was analyzed, and the findings indicated procedural errors. Assuming that the transmission of infections through the staff hands was significantly limited by the restrictive use of personal protective equipment, the search for a reservoir of microorganisms in the environment began. MDR strains were grown from the inoculations collected from the hand-wash basins in the wards and from inside the air conditioner on the ceiling outside the patient rooms. New types of decontamination mats were used in high-risk areas with a disinfectant based on Glucoprotamine. Active chlorine-containing substances were widely used to clean and disinfect surfaces. Conclusions: Infections with MDR strains pose a challenge for health care. Identification of bacterial reservoirs and comprehensive nursing care significantly reduce the number of nosocomial infections.

354. A Comparison of Different Strategies for Optimizing the Selection of Empiric Antibiotic Therapy for Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP) Caused by Gram-Negative Bacteria in Intensive Care Units (ICU)

Abstract Background Guidelines for HAP/VAP recommend considering local susceptibility data and patient specific risk factors for empiric therapy. However, data are lacking assessing whether a unit-specific combination antibiogram or a patient-specific factor-based approach will better drive appropriate empiric treatment. This study aims to hypothetically compare the two methods. Methods This retrospective study was conducted at Michigan Medicine between 2021-2022. Microbiological data of 221 non-duplicated, first Gram-negative respiratory isolates obtained from 190 patients in the MICU and SICU in 2021 were used to develop unit-specific combination antibiograms (Table 1) and individual patient charts were accessed to identify the impact of the presence/absence of various risk factors on antimicrobial susceptibility to define optimal regimens. Selected empiric regimens based on each approach are shown in Table 2. These two approaches were then hypothetically applied to 129 patients with positive respiratory cultures in 2022. The appropriateness, defined by having at least one in vitro active agent, and the overuse of antibiotics in empiric regimens by the two approaches were then assessed and compared. Results The breakdown of different empiric regimens selected based on the two approaches are shown in Table 3. Cefepime was the backbone β-lactam in regimens for both MICU and SICU by unit-specific combination antibiograms and in 83.7% of regimens based on patient-specific risk factors. Empiric regimens based on patient-specific risk factor had a higher rate of appropriateness than those based on antibiograms (89.1% vs 83.7%), with a 33.1% reduction in the rate of inappropriate empiric therapy. Additionally, using combination antibiograms resulted in a higher prevalence of antibiotic overuse than using patient-specific risk factors (72.9% vs. 40.3%), with most inappropriate use due to unnecessary aminoglycoside use. The overuse of other agents was comparable between approaches. Conclusion Both approaches were useful and can be applied in empiric antibiotic selection. However, the patient-specific risk factor-based approach offers advantages in reducing rates of inappropriate therapy and decreasing the overuse of combination agents. Disclosures jason M. Pogue, PharmD, AbbVie: Advisor/Consultant|Entasis: Advisor/Consultant|Ferring: Advisor/Consultant|GSK: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Qpex: Advisor/Consultant|Shionogi: Advisor/Consultant

Analysis on Bacterial Distribution and Change of Drug Resistance Rate in ICUs Across Southwest China from 2018 to 2022.

To analyze the distribution of bacteria and their drug resistance changes in Intensive Care Units (ICUs) across Southwest China from 2018 to 2022 and establish the antibiogram in this region to provide a basis for early empirical antimicrobial use. Non-repetitive pathogens isolated from 109 member units with qualified data were obtained from the Antimicrobial Resistance Surveillance System in Sichuan Province, southwest China. The results obtained were interpreted with reference to CLSI M100-31th, and analyzed with WHONET 5.6 software. A total of 46,728 clinical isolates in ICUs were collected from 2018 to 2022, of which gram-negative organisms accounted for 76.1%, and gram-positive were 23.9%. The top 5 were Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus, respectively. From 2018 to 2022, the resistance rates of Klebsiella pneumoniae to imipenem and meropenem changed from 14.5% and 17.8% to 14.0% and 14.4%, showing a steady downward trend. Escherichia coli was always highly sensitive to carbapenems, with a total resistance rate of 3.8%. Among non-fermented gram-negative bacteria, the resistance rates of Pseudomonas aeruginosa to imipenem and meropenem decreased significantly, changed from 25.3% and 22.9% in 2018 to 20.0% and 15.1% in 2022. However, Acinetobacter baumannii showed high resistance rates of 76.2% and 76.9% to imipenem and meropenem, respectively. MRSA and MRCNS accounted for 31.7% and 82.7%, respectively. No vancomycin and linezolid-resistant Staphylococcus aureus was isolated. Enterococcus faecalis maintained high activity to vancomycin, teicoplanin, and linezolid; no vancomycin or teicoplanin-resistant Enterococcus faecium strains were detected. From 2018 to 2022, the isolated bacteria in ICU were mainly gram-negative bacteria, and the growth of some multidrug-resistant bacteria was effectively controlled. All levels of medical institutions should continue to strengthen bacterial resistance surveillance, promote the establishment of antimicrobial stewardship program, and enhance restrictions on outpatient antimicrobial use.

Antibiotic Susceptibility Profiling of Human Pathogenic Staphylococcus aureus Strains Using Whole Genome Sequencing and Genome-Scale Annotation Approaches.

Staphylococcus species are major pathogens with increasing importance due to the rise in antibiotic resistance. Whole genome sequencing and genome-scale annotation are promising approaches to study the pathogenicity and dissemination of virulence factors in nosocomial methicillin-resistant and multidrug-resistant bacteria in intensive care units. Draft genome sequences of eight clinical S. aureus strains were assembled and annotated for the prediction of antimicrobial resistance genes, virulence factors, and phylogenetic analysis. Most of the studied S. aureus strains displayed multi-resistance toward the tested drugs, reaching more than seven drugs up to 12 in isolate S22. The mecA gene was detected in three isolates (S14, S21, and S23), mecC was identified in S8 and S9, and blaZ was commonly identified in all isolates except strain S23. Additionally, two complete mobile genomic islands coding for methicillin resistance SCCmec Iva (2B) were identified in strains S21 and S23. Numerous antimicrobial resistance genes (norA, norC, MgrA, tet(45), APH(3')-IIIa, and AAC(6')-APH(2″)) were identified in chromosomes of different strains. Plasmid analysis revealed the presence of blaZ, tetK, and ermC in different plasmid types, located in gene cassettes containing plasmid replicons (rep) and insertion sequences (IS). Additionally, the aminoglycoside-resistant determinants were identified in S1 (APH(3')-IIIa), while AAC(6)-APH(2″) was detected in strains S8 and S14. The trimethoprim (dfrC) resistance gene was detected in S. aureus S21, and the fosfomycin (fosB) resistance gene was detected only in S. aureus S14. We also noted that S. aureus S1 belongs to ST1-t127, which has been reported as one of the most frequent human pathogen types. Additionally, we noted the presence of rare plasmid-mediated mecC-MRSA in some of our isolates.

Active surveillance testing to reduce transmission of carbapenem-resistant, gram-negative bacteria in intensive care units: a pragmatic, randomized cross-over trial

BackgroundIn intensive care unit (ICU) settings, the transmission risk of carbapenem-resistant, gram-negative bacteria (CRGNB) is high. There is a paucity of data regarding the effectiveness of interventions, including active screening, preemptive isolation, and contact precautions, to reduce transmission of CRGNB.MethodsWe conducted a pragmatic, cluster-randomized, non-blinded cross-over study in 6 adult ICUs in a tertiary care center in Seoul, South Korea. ICUs were randomly assigned to perform active surveillance testing with preemptive isolation and contact precautions (intervention) or standard precautions (control) during the initial 6-month study period, followed by a 1-month washout period. During a subsequent 6-month period, departments that used standard precautions switched to using interventional precautions and vice versa. The incidence rates of CRGNB were compared between the two periods using Poisson regression analysis.ResultsDuring the study period, there were 2268 and 2224 ICU admissions during the intervention and control periods, respectively. Because a carbapenemase-producing Enterobacterales outbreak occurred in a surgical ICU (SICU), we excluded admissions to the SICU during both the intervention and control periods and performed a modified intention-to-treat (mITT) analysis. In mITT analysis, a total of 1314 patients were included. The acquisition rate of CRGNB was 1.75 cases per 1000 person-days during the intervention period versus 3.33 cases per 1000 person-days during the control period (IRR, 0.53 [95% confidence interval (CI) 0.23–1.11]; P = 0.07).ConclusionsAlthough this study was underpowered and showed borderline significance, active surveillance testing and preemptive isolation could be considered in settings with high baseline prevalence of CRGNB.Trial registration Clinicaltrials.gov Identifier: NCT03980197.

Tracking Epidemiological Characteristics and Risk Factors of Multi-Drug Resistant Bacteria in Intensive Care Units.

Multi-drug resistance (MDR) emerged as a serious threat in intensive care unit (ICU) settings. Our study aimed to investigate the major pathogens in ICU and identify the risk factors for MDR infection. We performed a retrospective analysis of patients admitted to the ICU. Multivariate logistic regression was applied to identify the independent predictors, and then a nomogram to predict the probability of MDR infection. A total of 278 patients with 483 positive cultures were included. 249 (51.55%) had at least one MDR pathogen, including extensively drug-resistant (XDR) 77 (30.92%) and pan drug-resistant (PDR) 39 (15.66%), respectively. Klebsiella pneumonia was the most frequently isolated pathogen. We identified the number of bacteria (OR 2.91, 95% CI 1.97-4.29, P < 0.001), multiple invasive procedures (OR 2.23, 95% CI 1.37-3.63, P = 0.001), length of stay (LOS) (OR 1.01, 95% CI 1.00-1.02, P = 0.007), Hemoglobin (Hb) (OR 0.99, 95% CI 0.98-1.00, P = 0.01) were independent risk factors for MDR infection. Our nomogram displayed good discrimination with curve AUC was 0.75 (95% CI: 0.70-0.81). The decision curves also indicate the clinical utility of our nomogram. Additionally, the in-hospital mortality with MDR pathogens was independently associated with XDR (HR, 2.60; 95% CI: 1.08-6.25; P = 0.03) and total protein (TP) (HR, 0.95; 95% CI: 0.91-0.99; P = 0.03). The number of bacteria, multiple invasive procedures, LOS, and Hb were the independent predictors associated with MDR pathogens. Our nomogram is potentially useful for predicting the occurrence of MDR infection. Besides, we also identify XDR and TP as the independent risk factors for in-hospital mortality with MDR infection. The current prevalence of MDR strains was also described. The results will contribute to the identification and preventive management of patients at increased risk of infection.

Role of surfaces and sinks in the control of multiresistant bacteria in Intensive Care Unit

Abstract Background Control of multiresistant bacteria (MRB) outbreaks in the Intensive Care Unit (ICU) is a challenge of Public Health. There is strong evidence that surfaces, and sinks are reservoirs of MRB. In 2020, because of isolation of Klebsiella type IMP, OXA-48 and VIM in moist reservoirs in ICU of Clinico San Cecilio Hospital and another carbapenemase-producing Enterobacteriaceae (CPE) outbreak, it arises our aim, which is to highlight the relevance of periodic control of humid reservoirs and surfaces in ICU to prevent MRB transmission. Methods Retrospective, descriptive study from March to June 2021. Due to a rise of cases of a CPE outbreak in our ICU in Granada, samples of surfaces and taps of different boxes were taken, after discharging patients and their corresponding terminal cleaning, whether they were CPE-colonised patient or not. Results Samples of 20 boxes were taken (N = 325). CPE OXA-48 was isolated in 7,38% of the samples which correspond to 40% of the boxes, most of them Enterobacter cloacae. 25% of the positive samples isolated two types of resistance, OXA-48, and VIM. 79,2% of the positive samples were found in March. The rest of them in April and May, after establishing control measures in surfaces. CPE was isolated in blood pressure monitor, pulse oximeter, electrocardiogram and stethoscope from 6 boxes. 3 CPE humid reservoirs were found in the tap and drain sinks of 2 boxes, one of them with CPE colonised patient. Conclusions We have observed the existence of carbapenem-resistant plasmids in surfaces and the persistence of humid reservoirs in our ICU, despite of establishing control measures of an outbreak. In conjunction with classical monitoring measures such as observation and training of hand hygiene, we recommend the use of disposable materials, systematic disinfection of reservoirs, appropriate use of gloves, chlorination of sinks and the goal of an ICU without water should be fundamental elements in the prevention of MRB transmission. Key messages • Multifactorial approach for the control of multiresistant bacteria outbreaks in the Intensive Care Unit. • Intensive Care Unit without water to avoid humid reservoirs of multiresistant bacterias.

Use of broad-spectrum antimicrobials for more than 72 h and the detection of multidrug-resistant bacteria in Japanese intensive care units: a multicenter retrospective cohort study

BackgroundLarge multicenter studies reporting on the association between the duration of broad-spectrum antimicrobial administration and the detection of multidrug-resistant (MDR) bacteria in the intensive care unit (ICU) are scarce. We evaluated the impact of broad-spectrum antimicrobial therapy for more than 72 h on the detection of MDR bacteria using the data from Japanese patients enrolled in the DIANA study.MethodsWe analyzed the data of ICU patients in the DIANA study (a multicenter international observational cohort study from Japan). Patients who received empirical antimicrobials were divided into a broad-spectrum antimicrobial group and a narrow-spectrum antimicrobial group, based on whether they received broad-spectrum antimicrobials for more or less than 72 h, respectively. Differences in patient characteristics, background of infectious diseases and empirical antimicrobial administration, and outcomes between the two groups were compared using the chi-square tests (Monte Carlo method) for categorical variables and the Mann–Whitney U-test for continuous variables. We also conducted a logistic regression analysis to investigate the factors associated with the detection of new MDR bacteria.ResultsA total of 254 patients from 31 Japanese ICUs were included in the analysis, of whom 159 (62.6%) were included in the broad-spectrum antimicrobial group and 95 (37.4%) were included in the narrow-spectrum antimicrobial group. The detection of new MDR bacteria was significantly higher in the broad-spectrum antimicrobial group (11.9% vs. 4.2%, p = 0.042). Logistic regression showed that broad-spectrum antimicrobial continuation for more than 72 h (OR [odds ratio] 3.09, p = 0.047) and cerebrovascular comorbidity on ICU admission (OR 2.91, p = 0.041) were associated with the detection of new MDR bacteria.ConclusionsAmong Japanese ICU patients treated with empirical antimicrobials, broad-spectrum antimicrobial usage for more than 72 h was associated with the increased detection of new MDR bacteria. Antimicrobial stewardship programs in ICUs should discourage the prolonged use of empirical broad-spectrum antimicrobial therapy.Trial registration ClinicalTrials.gov, NCT02920463, Registered 30 September 2016, https://clinicaltrials.gov/ct2/show/NCT02920463

Bacteriological aspects of bacteremia in the intensive care unit of the Mohammed V Military Hospital: 10 months prospective study.

Bacteremia is responsible for high rates of morbidity and mortality. The increasing prevalence of multidrug-resistant (MDR) bacteria in intensive care units (ICU) is a growing concern. Hence, prior knowledge of bacterial epidemiology and resistance phenotypes is required to optimize these infections' management. The objective of this study was to determine the epidemiological profile of bacteremia in ICU settings, as well as the place occupied by MDR bacteria in these infections. It is a prospective study carried out over 10 months on episodes of bacteremia in the ICU of Mohammed V Military Teaching Hospital (Rabat, Morocco). Microorganism growth was detected using fluorescent technology, species identification was based on morphological and biochemical characteristics. Antimicrobial susceptibility testing was performed following the recommendations of the Antibiogram Committee of the French Society of Microbiology (CA-SFM) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Among 504 hospitalized patients, sixty-one (12.1%) presented at least one episode of bacteremia. Forty patients (65.6% of bacteremic patients) presented at least one episode of bacteremia due to MDR bacteria. Male gender, cardiovascular diseases, diabetes and previous hospitalization were significant risk factors for the acquisition of MDR bacteremia. Isolated bacteria were mainly Gram-negative bacilli (GNB) (n = 62; 68.9%) dominated by Acinetobacter baumannii (n = 19; 21.1%) and Klebsiella pneumoniae (n = 16; 17.8%). MDR bacteria were represented by multi-resistant Acinetobacter baumannii (n = 19; 44.2%), extended-spectrum beta-lactamases-producing Enterobacterales (n = 9; 20.9%) and carbapenem-resistant Enterobacterales (n = 7; 16.3%). Carbapenems (n = 40; 65.6%), Aminoglycosides (n = 32; 52.5%) and Polypeptides (n = 24; 39.3%) were the most used antimicrobials. Mortality rates were 66.6% (n = 40) and 85% (n = 43) in patients with non MDR bacteremia and MDR bacteremia respectively. Limiting the spread of MDR bacteria and improving the management of bacteremic patients require continuous monitoring of bacteremia as well as adapting the therapeutic and preventive strategy.

Airborne bacterial and PM characterization in intensive care units: correlations with physical control parameters.

In this study, the spatial variation of airborne bacteria in intensive care units (ICUs) was characterized. Fine particulate matter and several physical parameters were also monitored including temperature and relative humidity. The results showed that the total bacterial load ranged between 20.4 and 134.3 CFU/m3 across the ICUs. Bacterial cultures of the collected samples did not isolate any multi-drug-resistant Gram-negative bacilli indicating the absence of such aerosolized pathogens in the ICUs. Meanwhile, particulate matter levels in several ICUs were found to exceed the international guidelines set for 24-h PM exposure. Moreover, examining bacterial load contribution by size suggested that bacteria with sizes less than 0.65 µm contributed the least to the total bacterial loads, while those with sizes between 0.65 and 1.1 µm contributed the most. A multiple linear regression model was also built to predict the bacterial loads in the ICUs. The regression analysis explained 77% of the variability observed in the measured bacterial concentrations. The model showed that the level of activity in the ICU rooms as well as its occupancy level had strong positive correlations with bacterial loads, while distance away from the patient had a non-linear relationship with measured loads. No statistically significant correlation was found between bacterial load and particulate matter concentrations.

Down the Drain: A Systematic Review of Molecular Biology Evidence Linking Sinks with Bacterial Healthcare-Associated Infections in Intensive Care Units

This systematic review aimed to sum up the evidence gathered by molecular biology methods on the transmission of bacterial clones from sinks/sink drains environmental sources to intensive care unit (ICU) patients. Forty-five reports meeting inclusion/exclusion criteria were identified. Most were retrospective cohort studies on Gram negative multidrug resistant bacteria, with P. aeruginosa and S. marcescens being the most frequent species (26.7% and 17.8% of the studies, respectively). The reports using pulse field gel electrophoresis were the most numerous (44.4%) and found a common clone between clinical and sink/sink drains isolates in 80% of the cases. Over the last 5 years, the use of whole genome sequencing became more frequent and linked sink/sink drains isolates to clinical ones in 50% of the cases. Precise positivity timelines mostly pointed towards a patient-to-sink/sink drain transmission while only 8 reports provided back up for the sink/sink drain-to-patient. To better appraise the role of sinks/sink drains as a reservoir for nosocomial acquisition of bacteria in ICU, future reports should strive to give a precise timeline for the retrieval of isolates as well as the cut-off criteria used to assign isolates to a given clone (information lacking in 66.7% and 42.2% of the studies, respectively).

Major Genetic Determinants of Extended-Spectrum Β-Lactamase (ESBL), Carbapenemase, Fosfomycin and Colistin Resistance in Escherichia Coli from Intensive Care Units

Escherichia coli (E. coli) strains placed in predominant nosocomial bacteria in intensive care units (ICUs), resulting in severe drug-resistant infections. Non-susceptibility to β-lactams and last-line drugs such as Fosfomycin and Colistin cause limited availability of infections eradication. The objective of this study included the determination of genes encoding extended-spectrum β-lactamase (ESBL), Carbapenemase, Colistin, and Fosfomycin resistance in clinical isolates of E. coli in ICUs. A total of 200 E. coli isolates were identified from ICU settings. The CTXM-1, SHV, IMP and OXA-48 genes were detected for β-lactamases using the polymerase chain reaction (PCR) technique. The fosA3 and mcr-1 and mcr-2 genes were also detected for resistance against Fosfomycin and Colistin. The CTX-M1, SHV, IMP and OXA-48 genes were detected in 60 (30%), 56 (28%), 28 (14%) and 4 (8%) of isolates. none of the E. coli isolates had the mcr-2 and fosA3 genes. Despite the existence of resistance genes to the third-generation antibiotics and Carbapenemase s, any isolates had genes for resistance to Fosfomycin and Colistin. More studies are needed to follow the resistance genes against last-resort antibiotics.

Prevalence and determinants of antimicrobial resistance of gram-negative bacteria in intensive care unit

Prevalence and determinants of antimicrobial resistance of gram-negative bacteria in intensive care unit

Prevalence of antibiotic resident bacteria in intensive care units at Hodeida City, Yemen

Prevalence of antibiotic resident bacteria in intensive care units at Hodeida City, Yemen

Antibiotic Susceptibility Pattern of Extended-Spectrum Beta-Lactamase-Producing Klebsiella Pneumoniae and Escherichia Coli

Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria is a type of resistance that leads to complex management of patients in intensive care due to their resistance to first, second, and third-generation Cephalosporin and monobactam antibiotics. The most ESBL-producing bacteria are found in the family Enterobacteriaceae, especially Klebsiella pneumoniae and Escherichia coli. The purpose of this research was to determine the sensitivity pattern of ESBLproducing bacteria in Intensive Care Units (ICUs) of Ulin Hospital, Banjarmasin, in the period of 2016-2018. This research was a descriptive study with a cross-sectional approach using data from the laboratory medical records of patients with positive ESBL in the ICUs of Ulin Hospital, Banjarmasin, between 2016 and 2018. The research sample was taken by the total sampling method. This research obtained 216 isolates of ESBL-producing bacteria consisting of 155 (71.8%) isolates of Klebsiella pneumoniae and 61 (28.2%) Escherichia coli. It was found that the Cephalosporin antibiotics (Cefazolin, Ceftazidime, Ceftriaxone, and Cefepime) and monobactam antibiotic (Aztreonam) had the lowest sensitivity. Aminoglycoside antibiotics (Amikacin), Carbapenem (Ertapenem and Meropenem), and Tetracycline (Tigesycline) were the most sensitive antibiotics. It was concluded that both Klebsiella pneumoniae and Escherichia coli were the most dominant ESBL-producing bacteria and showed good sensitivity to the Amikacin, Ertapenem, Meropenem, and Tigecycline.

English

BACKGROUND The Carbapenemase Resistant Enterobacteriaceae (CRE) are associated with high rates of morbidity and mortality particularly amongst critically ill patients. Hence rapid laboratory detection of CRE hospitalized patients is highly desirable. The vast majority of carbapenemases belong to three of the four known classes of beta lactamases namely Ambler class A, Ambler class B metallobetalactamases (MBL) and Ambler class Doxacillinases (OXAs). The purpose of this study was to determine the prevalence of carbapenemases producing Enterobacteriaceae in clinical isolates in MBS hospital, Kota. METHODS This study was conducted in the Department of Microbiology at MBS Hospital, Kota from June 2020 to December 2020. 68 non repeat isolates (MDR) that were resistant to imipenem (10 mg) according to CLSI breakpoint were included in the present study. RESULTS Out of 68 imipenem resistant Enterobacteriaceae, 52 were carbapenemase producing as detected by Modified Hodge Test. As per our study, the prevalence of carbapenemase producing Enterobacteriaceae was 20.8%. Most commonly seen in K. pneumoniae isolated from urine and swab of critically ill and debilitated patients of surgical ward. CONCLUSIONS Curbing irrational usage of antimicrobials in India is urgently required. Thus, aggressive infection control efforts have been effective at decreasing rates of infections with KPC-producing bacteria in intensive care units and long-term acute care hospitals. Bundled interventions including enhanced environmental cleaning, active surveillance culturing and contact precautions, as well as antimicrobial stewardship are important in controlling KPC-producing bacteria. KEY WORDS Multi Drug Resistance Enterobacteriaceae (MDRE), Klebsiella Producing Carbapenemase (KPC), Carbapenem Resistant Enterobacteriaceae (CRE), Metallo Beta Lactamase (MBL), Modified Hodge Test (MHT)

Multimodal intervention to reduce acquisition of carbapenem-non-susceptible Gram-negative bacteria in intensive care units in the National Referral Hospital of Indonesia: An interrupted time series study.

To evaluate a low-cost multimodal intervention on the acquisition of carbapenem-non-susceptible Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa by patients in low-resource intensive care units. We performed a quasi-experimental study in a referral hospital in Jakarta, Indonesia: pre-intervention phase 1 (2013-2014), intervention phase 2 (2014-2015) and post-intervention phase 3 (2015-2016). The intervention was hand hygiene promotion and environmental cleaning and disinfection combined with patient disinfection and cohorting. The primary outcome was acquisition of resistant bacteria per 100 patient-days at risk, which was assessed by active microbiological surveillance and analysed with a multilevel Poisson segmented regression model. In phase 1 (387 patients), the acquisition rate was 4.3/100 days for carbapenem-non-susceptible A. baumannii versus 1.1/100 days for both K. pneumoniae and P. aeruginosa. There was a significant step change from phase 1 to phase 3 (361 patients) in the acquisition of carbapenem-non-susceptible strains, the incidence rate ratio (IRR) was 0.343 (99%CI: 0.164-0.717). This significant change was mainly due to reduced acquisitions of resistant A. baumannii (IRR 0.4, 99%CI: 0.181-1.061). Negative confounding was observed. A multimodal intervention to prevent acquisition of resistant pathogens is feasible and may be effective in ICUs in lower-middle income countries.