Prevalence, Pattern, and Outcome of Infection with Multidrug-Resistant Organisms in Respiratory ICU at Al-Abbassya Chest Hospital
Authors: Abd Elazeem Abeer Abd Elzaher , Khalil Magdy Mohamed , Osman Nehad Mohammed , Adel Ashraf 
Published: November 2024

Abstract

Background
Over the last several decades, antibacterial drug use has become widespread with their misuse being an ever-increasing phenomenon. Consequently, antibacterial drugs have become less effective or even ineffective, resulting in a global health security emergency Zilahi et al., (2016). Critically ill patients admitted to the Respiratory Intensive care unit (ICU) have demonstrated an increased incidence of antimicrobial resistance compared to other hospitalized patients. Therefore, efforts should be exerted to reveal the contributing epidemiological factors for antimicrobial resistance to reduce mortality as well as health care costs Moolchandani et al., (2017). 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 Wang et al., (2019).

Objectives
This study was undertaken to determine prevalence, pattern, and outcome of infection with multidrug-resistant organisms in Respiratory ICU at al-Abbassya Chest Hospital and was conducted from May 2018 to May 2019.

Material and Methods
Patients admitted in ICU except patients &lt;18 years old, patients with active tuberculosis and patients refused to participate or transferred to other places or died within 48 hours of the study were excluded from this study, Data from 196 patients was collected at the time of admission, all patients were subjected to full history taking, thorough clinical examination, full laboratory investigations, assessment of comorbidities, and radiological investigations. Bacterial cultures and antibiogram were done to patients with symptoms suggestive of lower respiratory tract infection or presenting with extrapulmonary infection. The results of cultures were classified to cultures with non-significant results (no growth or normal flora) and cultures with significant growth (total of 99 which were included in analysis)

Results
In the present study, 67.7% of cases were males, 58.6% of cases were smokers and 68.7 % of cases had previous hospital admission, Diabetes mellitus was the most frequent comorbidity (25.3 % of patients) and the most frequent comorbidity with MDR. Infective exacerbation of COPD was the most frequent infection (42.4 % of the studied cases), 67.7% of them had type II respiratory failure. 77.8% of cases required mechanical ventilation and mortality occurred in about half of cases. Gram negative bacteria represented 83.19% of isolates, with K. pneumoniae presenting 50.5% of them. MDR was detected in more than three quarters of the studied cases with K. pneumoniae (57.3%) and Acinetobacter (30.5%) the most frequent. 76.8% of MDR bacteria were sensitive in vitro to colistin antibiotic. Occurrence of MDR bacterial infection did not correlate to a specific risk factor. There was however, a trend of increased MDR in patients with frequent antibiotic use before hospital admission

Conclusion
Infection with MDR pathogens were frequent in patients admitted to respiratory ICU. In the current study Klebsiella and Acintobacter presented the majority of MDR isolates and colistin was the drug which most frequently showed in vitro activity against isolates. Prior use of antibiotics seems to be a significant predisposing factor to development of infection with MDR organisms.