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VOLUME 66 , ISSUE 3 ( July-September, 2024 ) > List of Articles

ORIGINAL RESEARCH

Incidence and Clinical Outcomes of Multidrug-resistant Respiratory Infection in the Intensive Care Units of a Tertiary Care Hospital: A Prospective, Observational Study

Meghana Sanil, Pratibha Todur, Varun R Nayak, Souvik Chaudhuri

Keywords : Gram-negative bacteria, Incidence, Intensive care unit, Multidrug resistance

Citation Information : Sanil M, Todur P, Nayak VR, Chaudhuri S. Incidence and Clinical Outcomes of Multidrug-resistant Respiratory Infection in the Intensive Care Units of a Tertiary Care Hospital: A Prospective, Observational Study. Indian J Chest Dis Allied Sci 2024; 66 (3):89-93.

DOI: 10.5005/jp-journals-11007-0124

License: CC BY-NC 4.0

Published Online: 19-11-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Background: The surge in income levels coupled with reduced drug costs has contributed to a notable escalation in the utilization of antibiotics among individuals, consequently fostering the emergence of antibiotic resistance. Despite the detrimental effects of antibiotic resistance on patient outcomes, there exists a significant gap in global research, particularly in middle- and low-income countries. Hence, we aimed to evaluate the burden of gram-negative multidrug-resistant (GNB-MDR) respiratory infections in mechanically ventilated patients. Materials and methods: A single center, prospective-observational study was performed in the intensive care units (ICU) of a Tertiary Care Hospital in Southern India from September 2021 to May 2022. Endotracheal aspirates were collected as per the physician's order and using the standard microbiological methods, gram-negative bacteria were identified, and their antibiotic susceptibility patterns were obtained. Demographic data of patients, clinical profile of the organism and clinical outcomes including the hospital stay, ICU stay and weaning from mechanical ventilation were documented. Results: Among the 418 admitted patients, the incidence of gram-negative bacteria was 21.5%, among which the occurrence of multidrug-resistant gram-negative bacteria (MDR-GNB) was 16.26%. Acinetobacter baumannii (57.7%) was the most commonly found species, followed by Klebsiella pneumoniae (38.8%) and Escherichia coli (6.6%). About 77.7% of the cohort were carbapenem resistant, of which 90% cases were multidrug resistant. Significantly more MDR-GNB patients have undergone simple and difficult weaning compared to non-multidrug-resistant gram-negative bacteria (NMDR-GNB) infected patients (p = 0.026). Interpretation and conclusion: The rising prevalence of antibiotic resistance, notably carbapenem resistance, emphasizes the importance of observing the trends in the resistance pattern and conducting routine surveillance in critical care settings to alleviate the associated mortality and morbidity.

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  1. Cox D. Antibiotic resistance: The race to stop the silent tsunami facing modern medicine. The Guardian 2015;41(5):320–327. [online]. Available from: https://www.theguardian.com/society/blog/2015/aug/21/antibiotic-resistance-the-race-to-stop-the-silent-tsunami-facing-modern-medicine. [Last accessed October, 2024].
  2. Rodrigo-troyano A, Sibila O. The respiratory threat posed by multidrug resistant Gram-negative bacteria. Respirology 2017;22(7):1288–1299. DOI: 10.1111/resp.13115.
  3. Siwakoti S, Subedi A, Sharma A, et al. Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal-a prospective cohort study. Antimicrobial Resist Infect Control 2018;7(1):114.
  4. Reale M, Strazzulla A, Quirino A, et al. Patterns of multi-drug resistant bacteria at first culture from patients admitted to a third level University hospital in Calabria from 2011 to 2014: Implications for empirical therapy and infection control. Infez Med 2017;25(2):98–107. PMID: 28603227.
  5. Chaudhry D, Prajapat B. Intensive care unit bugs in India: How do they differ from the Western world? J Assoc Chest Physicians 2017;5(1):10–17. DOI: 10.4103/2320-8775.196645.
  6. Mendes RE, Mendoza M, Banga Singh KK, et al. Regional resistance surveillance program results for 12 Asia Pacific nations (2011). Antimicrob Agents Chemother 2013;57(11):5721–5726. DOI: 10.1128/AAC.01121-13.
  7. Ghanshani R, Gupta R, Gupta BS, et al. Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India. Lung India 2015;32(5):441–448. DOI: 10.4103/0970-2113.164155.
  8. World Health Organization. Antimicrobial resistance. [online]. Available from: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. [Last accessed October, 2024].
  9. Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA 2009;302(21):2323–2229. DOI: 10.1001/jama.2009.1754.
  10. Blot S, Ruppé E, Harbarth S, et al. Healthcare-associated infections in adult intensive care unit patients: Changes in epidemiology, diagnosis, prevention and contributions of new technologies. Intensive Crit Care Nurs 2022;70:103227. DOI: 10.1016/j.iccn.2022.103227.
  11. Seligman R, Ramos-Lima LF, Oliveira VD, et al. Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia. J Bras Pneumol 2013;39(3):339–348. DOI: 10.1590/S1806-37132013000300011.
  12. Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: Mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42(Suppl 2):S82–S89. DOI: 10.1086/499406.
  13. Ben-David D, Kordevani R, Keller N, et al. Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect 2012;18(1):54–60. DOI: 10.1111/j.1469-0691.2011.03478.x.
  14. Blot S, Vandewoude K, De Bacquer D, et al. Nosocomial bacteremia caused by antibiotic-resistant gram-negative bacteria in critically ill patients: Clinical outcome and length of hospitalization. Clin Infect Dis 2002;34(12):1600–1606. DOI: 10.1086/340616.
  15. Menashe G, Borer A, Yagupsky P, et al. Clinical significance and impact on mortality of ESBL-producing gram-negative isolates in nosocomial bacteremia. Scand J Infect Dis 2001;33(3):188–193 PMID: 11303808
  16. Vishwanath S, Chawla K, Gopinathan A. Multidrug resistant Gram-negative bacilli in lower respiratory tract infections. Iran J Microbiol 2013;5(4):323–327. PMID: 25848499.
  17. Gandra S, Tseng KK, Arora A, et al. The mortality burden of multidrug-resistant pathogens in India: A retrospective, observational study. Clin Infect Dis 2019;69(4):563–570. DOI: 10.1093/cid/ciy955.
  18. Basak S, Singh P, and Rajurkar M. Multidrug-resistant and extensively drug-resistant bacteria: A study. J Pathog 2016;2016:4065603. DOI: 10.1155/2016/4065603.
  19. Gupta R, Malik A, Rizvi M, et al. Epidemiology of multidrug-resistant Gram-negative pathogens isolated from ventilator-associated pneumonia in ICU patients. J Glob Antimicrob Resist 2017;9:47–50. DOI: 10.1016/j.jgar.2016.12.016.
  20. Coudron PE. Inhibitor-based methods for detection of plasmid-mediated AmpC β-lactamases in Klebsiella spp., Escherichia coli, and Proteus mirabilis. JClin Microbiol 2005;43(8):4163–4167. DOI: 10.1128/JCM.43.8.4163-4167.2005.
  21. Picao RC, Andrade SS, Nicoletti AG, et al. Metallo-β-lactamase detection: Comparative evaluation of double-disk synergy versus combined disk tests for IMP-, GIM-, SIM-, SPM-, or VIM-producing isolates. J Clin Microbiol 2008;46(6):2028–2037. DOI: 10.1128/JCM.00818-07.
  22. Sherchan JB, Humagain S. Antimicrobial susceptibility pattern of gram-negative bacteria causing lower respiratory tract infections in Kathmandu university hospital. J Nepal Health Res Counc 2021;18(4):661–666. DOI: 10.33314/jnhrc.v18i4.2566.
  23. Teerawattanapong N, Panich P, Kulpokin D, et al. A systematic review of the burden of multidrug-resistant healthcare-associated infections among intensive care unit patients in Southeast Asia: The rise of multidrug-resistant Acinetobacter baumannii. Infect Control Hosp Epidemiol 2018;39(5):525–533. DOI: 10.1017/ice.2018.58.
  24. Guclu AU, Kocak AA, Ok MA, et al. Antibacterial resistance in lower respiratory tract bacterial pathogens: A multicenter analysis from turkey. J Infect Dev Ctries 2021;15(02):254–262. DOI: 10.3855/jidc.12599.
  25. Kannian P, Mahanathi P, Ashwini V, et al. Carbapenem-resistant gram negative bacilli are predominantly multidrug or pan-drug resistant. Microb Drug Resist 2021;27(8):1057–1062. DOI: 10.1089/mdr.2020.0294.
  26. Ramirez MS, Bonomo RA, Tolmasky ME. Carbapenemases: Transforming Acinetobacter baumannii into a yet more dangerous menace. Biomolecules 2020;10(5):720. DOI: 10.3390/biom10050720.
  27. Brotfain E, Borer A, Koyfman L, et al. Multidrug resistance acinetobacter bacteremia secondary to ventilator-associated pneumonia: Risk factors and outcome. J Intensive Care Med 2017;32(9):528–534. DOI: 10.1177/0885066616632193.
  28. Bickenbach J, Schöneis D, Marx G, et al. Impact of multidrug-resistant bacteria on outcome in patients with prolonged weaning. BMC Pulm Med 2018;18(1):141. DOI: 10.1186/s12890-018-0708-3.
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