Zorgani Abdulaziz, Abofayed Atef, Glia Abdulhakim, Albarbar Ashrf, Hanish Sami
Department of Microbiology, University of Tripoli, Tripoli, Libya.
Abusalim Trauma Hospital, Tripoli, Libya.
Oman Med J. 2015 Jul;30(4):270-5. doi: 10.5001/omj.2015.54.
Device-associated nosocomial infections (DANIs) have a major impact on patient morbidity and mortality. Our study aimed to determine the distribution rate of DANIs and causative agents and patterns of antibiotic resistance in the trauma-surgical intensive care unit (ICU). .
Our study was conducted at Abusalim Trauma Hospital in Tripoli, Libya. All devices associated with nosocomial infections, including central venous catheters (CVC), endotracheal tubes (ETT), Foley's urinary catheters, chest tubes, nasogastric tubes (NGT), and tracheostomy tubes, were removed aseptically and examined for Gram-negative bacteria (GNB). .
During a one-year study period, 363 patients were hospitalized; the overall mortality rate was 29%. A total of 79 DANIs were identified, the most common site of infection was ETT (39.2%), followed by urinary catheters (19%), NGTs (18%), tracheostomy tubes (11%), CVCs (10%), and chest tubes (3%). The most frequently isolated organisms were Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeruginosa (30%, 20%, and 14%, respectively). Extremely high resistance rates were observed among GNB to ampicillin (99%), cefuroxime (95%), amoxicillin-clavulante (92%), and nitrofurantoin (91%). Lower levels of resistance were exhibited to amikacin (38%), imipenem (38%), and colistin (29%). About 39% of the isolates were defined as multi-drug resistant (MDR). Overall, extended spectrum β-lactmase producers were expressed in 39% of isolates mainly among K. pneumonia (88%). A. baumannii isolates exhibited extremely high levels of resistance to all antibiotics except colistin (100% sensitive). In addition, 56.3% of A. baumannii isolates were found to be MDR. P. aeruginosa isolates showed 46%-55% effectiveness to anti-pseudomonas antibiotics. .
High rates of DANI's and the emergence of MDR organisms poses a serious threat to patients. There is a need to strengthen infection control within the ICU environment, introduce surveillance systems, and implement evidence-based preventive strategies.
与设备相关的医院感染（DANIs）对患者的发病率和死亡率有重大影响。我们的研究旨在确定创伤外科重症监护病房（ICU）中DANIs的分布率、病原体及抗生素耐药模式。
我们的研究在利比亚的黎波里的阿布萨利姆创伤医院进行。所有与医院感染相关的设备，包括中心静脉导管（CVC）、气管内导管（ETT）、弗利氏导尿管、胸管、鼻胃管（NGT）和气管造口管，均无菌移除并检查革兰氏阴性菌（GNB）。
在为期一年的研究期间，363名患者住院；总死亡率为29%。共鉴定出79例DANIs，最常见的感染部位是ETT（39.2%），其次是导尿管（19%）、NGT（18%）、气管造口管（11%）、CVC（10%）和胸管（3%）。最常分离出的病原体是肺炎克雷伯菌、鲍曼不动杆菌和铜绿假单胞菌（分别为30%、20%和14%）。观察到GNB对氨苄西林（99%）、头孢呋辛（95%）、阿莫西林 - 克拉维酸（92%）和呋喃妥因（91%）的耐药率极高。对阿米卡星（38%）、亚胺培南（38%）和黏菌素（29%）的耐药水平较低。约39%的分离株被定义为多重耐药（MDR）。总体而言，39%的分离株中表达了超广谱β - 内酰胺酶产生菌，主要在肺炎克雷伯菌中（88%）。鲍曼不动杆菌分离株对除黏菌素外的所有抗生素均表现出极高的耐药水平（100%敏感）。此外，56.3%的鲍曼不动杆菌分离株被发现为MDR。铜绿假单胞菌分离株对抗假单胞菌抗生素的有效性为46% - 55%。
DANI的高发生率和MDR病原体的出现对患者构成严重威胁。有必要加强ICU环境中的感染控制，引入监测系统，并实施循证预防策略。
