Iranian Journal of Pathology

Antibiotic Resistance Pattern in Intensive Care Units in a Large Referral Hospital in Iran

Document Type : Original Research

Authors

Samaneh Salarvand 1
Alireza Abdollahi 1
Pegah Afarinesh Khaki 2
Mahsa Norouzi Shadehi 2
Mohammad Taghi Beigh Mohammadi 3
Seyed Amir Miratashi Yazdi 4
Elham Nazar 5

1 Department of Pathology, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Central Laboratory, Imam Khomeini Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran

3 Department of Intensive care medicine, Imam Khomeini complex hospital, Tehran University of Medical Sciences, Tehran, Iran

4 Department of General Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

5 Department of Pathology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

https://doi.org/10.30699/ijp.2023.1990807.3073
Abstract
Background & Objective: Antibiotic resistance, especially in the form of multidrug-resistant (MDR), is a big problem, especially in intensive care units (ICUs). This study aimed to evaluate antibiotic resistance and MDR patterns among patients hospitalized in the ICUs in one of the large referral centers in Iran.
Methods: The present study was conducted at Imam Khomeini Hospital in Tehran (a great referral hospital), which admits critically ill patients requiring ICU services. To determine the rate of positive cultures for resistant strains, the patient’s blood specimens were sent to the laboratory of the hospital for inoculation on proper culture media within 2 hours of extraction. Antimicrobial susceptibility tests were done using the Bauer–Kirby disk diffusion method.
Results: A total of 1,755 samples were collected from the patients to assess microbial strains and antibiotic resistance. The most common microbial strains detected in the cultures extracted from peripheral blood samples were Klebsiella pneumonia (22.1%), Staphylococcus epidermidis (7.9%) and another coagulase-negative Staphylococcus (15.0%). The antibiogram test showed antibiotic resistance in 1,509 cases, leading to a resistance prevalence rate of 85.9%. The most common antimicrobial resistance observed was against cotrimoxazole (61.7%), ciprofloxacin (51.3%), imipenem (50.0%), and ampicillin (49.6%). The rate of MDR was found to be 96.3%.
Conclusion: In Iran’s ICUs, a significantly high level of antibiotic resistance may be seen especially the MDR pattern, which indicates the need to change the pattern of prescribing and managing these drugs in ICU centers.

Keywords

Antibiotic-resistant, Blood culture
Intensive care unit

Subjects

  1. McEwen SA, Collignon PJ. Antimicrobial resistance: a one health perspective. Antimicrobial resistance in bacteria from livestock and companion animals. 2018 Oct 1:521-47. [DOI:10.1128/9781555819804.ch25]
  2. Christaki E, Marcou M, Tofarides A. Antimicrobial resistance in bacteria: mechanisms, evolution, and persistence. J Mol Evol. 2020 Jan;88:26-40. [DOI:10.1007/s00239-019-09914-3] [PMID]
  3. Boparai JK, Sharma PK. Mini review on antimicrobial peptides, sources, mechanism and recent applications. Protein Pept Lett. 2020;27(1):4-16. [PMID]  [DOI:10.2174/0929866526666190822165812]
  4. Septimus EJ. Antimicrobial resistance: an antimicrobial/diagnostic stewardship and infection prevention approach. Med Clin. 2018;102(5):819-29. [DOI:10.1016/j.mcna.2018.04.005] [PMID]
  5. Ferri M, Ranucci E, Romagnoli P, Giaccone V. Antimicrobial resistance: A global emerging threat to public health systems. Critical reviews in food science and nutrition. 2017;57(13): 2857-76. [DOI:10.1080/10408398.2015.1077192] [PMID]
  6. Chernov VM, Chernova OA, Mouzykantov AA, Lopukhov LL, Aminov RI. Omics of antimicrobials and antimicrobial resistance. Expert Opin Drug Discov. 2019 May 4;14(5):455-68. [DOI:10.1080/17460441.2019.1588880] [PMID]
  7. Campion M, Scully G. Antibiotic use in the intensive care unit: optimization and de-escalation. J Intensive Care Med. 2018;33(12):647-55. [DOI:10.1177/0885066618762747] [PMID]
  8. MacVane SH. Antimicrobial resistance in the intensive care unit: a focus on gram-negative bacterial infections. J Intensive Care Med. 2017;32(1):25-37. [DOI:10.1177/0885066615619895] [PMID]
  9. Gandhi TN, DePestel DD, Collins CD, Nagel J, Washer LL. Managing antimicrobial resistance in intensive care units. Crit Care Med. 2010;38: S315-23. [PMID] [DOI:10.1097/CCM.0b013e3181e6a2a4]
  10. Fridkin SK. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med. 2001;29(4):N64-8. [PMID] [DOI:10.1097/00003246-200104001-00002]
  11. Ikhimiukor OO, Odih EE, Donado-Godoy P, Okeke IN. A bottom-up view of antimicrobial resistance transmission in developing countries. Nat Microbiol. 2022 Jun;7(6):757-65. [DOI:10.1038/s41564-022-01124-w] [PMID]
  12. Long B, Koyfman A. Best clinical practice: blood culture utility in the emergency department. The J Emerg Med. 2016;51(5):529-39. [DOI:10.1016/j.jemermed.2016.07.003] [PMID]
  13. Towns ML, Jarvis WR, Hsueh PR. Guidelines on blood cultures. J Microbiol Immunol Infect. 2010 Aug 1;43(4):347-9. [DOI:10.1016/S1684-1182(10)60054-0] [PMID]
  14. Hombach M, Bloemberg GV, Böttger EC. Effects of clinical breakpoint changes in CLSI guidelines 2010/2011 and EUCAST guidelines 2011 on antibiotic susceptibility test reporting of Gram-negative bacilli. J Antimicrob Chemother. 2012 Mar 1;67(3):622-32. [DOI:10.1093/jac/dkr524] [PMID]
  15. Shafazand S, Weinacker AB. Blood cultures in the critical care unit: improving utilization and yield. Chest. 2002 Nov 1;122(5):1727-36. [DOI:10.1378/chest.122.5.1727] [PMID]
  16. Van Steenkiste T, Ruyssinck J, De Baets L, Decruyenaere J, De Turck F, Ongenae F, Dhaene T. Accurate prediction of blood culture outcome in the intensive care unit using long short-term memory neural networks. Med Artif Intell. 2019;97:38-43. [DOI:10.1016/j.artmed.2018.10.008] [PMID]
  17. Russo E, Bolondi G, Gamberini E, Santonastaso DP, Circelli A, Spiga M, Sambri V, Agnoletti V. Increased blood culture contamination rate during COVID-19 outbreak in intensive care unit: A brief report from a single-centre. J Intens Care Soc. 2022;23(4):500-2. [DOI:10.1177/17511437211012152] [PMID]
  18. Alahmadi YM, McElnay JC, Kearney MP, Aldeyab MA, Magee FA, Hanley J, Bailie R, Donaldson W, Johnston K, Kinoulty S, Doherty A. Tackling the problem of blood culture contamination in the intensive care unit using an educational intervention. Epidemiol Infect. 2015;143(9):1964-71. [DOI:10.1017/S0950268814003008] [PMID]
  19. Sorsa A, Früh J, Stötter L, Abdissa S. Blood culture result profile and antimicrobial resistance pattern: a report from neonatal intensive care unit (NICU), Asella teaching and referral hospital, Asella, south East Ethiopia. Antimicrob Resist Infect Control. 2019 Dec;8:1-6. [DOI:10.1186/s13756-019-0486-6] [PMID]
  20. Perez F, Hujer AM, Hujer KM, Decker BK, Rather PN, Bonomo RA. Global challenge of multidrug-resistant Acinetobacter baumannii. Antimicrob Agents Chemother. 2007;51(10): 3471-84. [DOI:10.1128/AAC.01464-06] [PMID]
  21. Shrestha S, Amatya R, Shrestha RK, Shrestha R. Frequency of blood culture isolates and their antibiogram in a teaching hospital. Journal of Nepal Medical Association. 2014;52(193):692-. [DOI:10.31729/jnma.2295]
  22. Tran GM, Ho-Le TP, Ha DT, Tran-Nguyen CH, Nguyen TS, Pham TT, et al. Patterns of antimicrobial resistance in intensive care unit patients: a study in Vietnam. BMC infectious diseases. 2017;17:1-7. [DOI:10.1186/s12879-017-2529-z] [PMID]
  23. Saxena G, Kalra SS, Gupta NE. Antimicrobial activity pattern of certain terpenoids. Int J Pharm Bio Sci. 2011;2(1):87-91.
  24. Bagherian F, Nikoonejad A, Allami A, Dodangeh S, Yassen LT, Hosienbeigi B. Investigation of Antibiotic Resistance Pattern in Isolated From Urine and Blood Samples of Patients Admitted To the Intensive Care Unit of Velayat Hospital in Qazvin, Iran. Med Lab J. 2021;15(6):31-7.
  25. Saleh Ahmed M, Abdulrahman ZF, Taha ZM. Risk Factors of Clonally Related, Multi, and Extensively Drug-Resistant Acinetobacter baumannii in Severely Ill COVID-19 Patients. Can J Infect Dis Med Microbiol. 2023;2023. [DOI:10.1155/2023/3139270] [PMID]
  26. Alenazi TA, Shaman MS, Suliman DM, Alanazi TA, Altawalbeh SM, Alshareef H, et al. The Impact of Multidrug-Resistant Acinetobacter baumannii Infection in Critically Ill Patients with or without COVID-19 Infection. InHealthcare 2023 Feb 8 (Vol. 11, No. 4, p. 487). MDPI. [DOI:10.3390/healthcare11040487] [PMID]
  27. Elsorady KE, Hassan RA, Abdelhamid DH, Abd El-Mohsen M. Antibiotics use and its association with Multi-Drug Resistance in a Tertiary Care Geriatrics Hospital in Egypt. J Infect Dev Countries. 2022 Dec 19;16(12):1860-9. [DOI:10.3855/jidc.17257] [PMID]
  28. Tariq TM. Bacteriologic profile and antibiogram of blood culture isolates from a children’s hospital in Kabul. J Coll Phys Surg Pak. 2014 Jun 1;24(6):396-9.
  29. De Bus L, Denys W, Catteeuw J, Gadeyne B, Vermeulen K, Boelens J, Claeys G, De Waele JJ, Decruyenaere J, Depuydt PO. Impact of de-escalation of beta-lactam antibiotics on the emergence of antibiotic resistance in ICU patients: a retrospective observational study. Intens Care Med. 2016;42:1029-39. [DOI:10.1007/s00134-016-4301-z] [PMID]
  30. Wolfensberger A, Sax H, Weber R, Zbinden R, Kuster SP, Hombach M. Change of antibiotic susceptibility testing guidelines from CLSI to EUCAST: influence on cumulative hospital antibiograms. PloS One. 2013;8(11):e79130. [DOI:10.1371/journal.pone.0079130] [PMID] 
Iranian Journal of Pathology
Volume 18, Issue 4
Autumn 2023
Pages 433-438

  • Receive Date 06 March 2023
  • Accept Date 30 May 2023

Home

Guide for Authors

Submit Manuscript

Contact Us