Laboratory of Medical Analysis, Ibn Tofail Hospital, University Hospital Center-Mohammed VI, Marrakesh, Morocco; Laboratory of Biology and Biotechnology of Microorganisms, Faculty of Sciences Semlalia, Cadi Ayyad University, Marrakesh, Morocco.
Laboratory of Medical Analysis, Ibn Tofail Hospital, University Hospital Center-Mohammed VI, Marrakesh, Morocco.
J Infect Public Health. 2020 Apr;13(4):637-643. doi: 10.1016/j.jiph.2019.08.012. Epub 2019 Sep 16.
Intensive care units (ICUs) are considered epicenters of antibiotic resistance. The aim of this study is to determine clinical risk factors, epidemiology and the causative agents of multi-drug resistant bacteria in the ICU of the University Hospital in Marrakesh-Morocco.
A one year case control study was carried out in our 10-bed clinical and surgical ICU from March 2015 to March 2016. The epidemiological surveillance was done by collecting data in the medical records with the help of a questionnaire. The antibiotic susceptibility testing was used following the recommendations of the Antibiogram Committee of the French Society of Microbiology and the European Committee for Antimicrobial Susceptibility Testing, 2015.
Among the 479 admitted patients, 305 bacteria were isolated and identified as Acinetobacter baumannii (31%), Enterobactereacae species (30%), and Staphylococcus (24%), P. aeruginosa (10%) and other bacterial strains (5%). The rate of MDR bacteria acquisition was 41% (124/305) with domination of A. baumannii resistant to imipenem (70%) and followed by Extended Spectrum β-lactamases producing Enterobacteriaceae, P. aeruginosa resistant to Ceftazidime, and Methicillin-resistant S. aureus (18%, 7%, and 5% respectively). The distribution of the common nosocomial infections were dominated by pneumonia, bacteremia, and catheter-related blood stream infections (39%, 29%, and 17%) respectively. Multivariate analysis identified lack of patient isolation precautions (OR: 7.500), use of quadri or triple therapy (OR: 5.596; OR: 5.175), and mechanical ventilation (OR: 4.926), as the most significant clinical and epidemiological factors associated with acquisition of MDR bacteria. The attributable mortality, in this ICU, of patients with MDR bacteria, is about 12%.
The incidence of MDR was higher compared with that of developed countries. The implementation of standard infection control protocols, active surveillance of MDR and generation of data on etiological agents and their antimicrobial susceptibility patterns are urgently needed in our hospital.
重症监护病房（ICU）被认为是抗生素耐药性的中心。本研究旨在确定摩洛哥马拉喀什大学医院 ICU 中多重耐药菌的临床危险因素、流行病学和病原体。
我们在 2015 年 3 月至 2016 年 3 月进行了为期一年的 ICU 临床和外科 10 床病例对照研究。通过使用问卷在病历中收集数据进行流行病学监测。抗生素药敏试验按照法国微生物学会和欧洲抗菌药物敏感性试验委员会 2015 年的建议进行。
在 479 名入院患者中，分离并鉴定出 305 株细菌，分别为鲍曼不动杆菌（31%）、肠杆菌科（30%）和葡萄球菌（24%）、铜绿假单胞菌（10%）和其他细菌株（5%）。MDR 细菌的获得率为 41%（124/305），其中鲍曼不动杆菌对亚胺培南耐药率最高（70%），其次是产超广谱β-内酰胺酶的肠杆菌科、头孢他啶耐药的铜绿假单胞菌和耐甲氧西林的金黄色葡萄球菌（分别为 18%、7%和 5%）。常见医院感染的分布以肺炎、菌血症和导管相关血流感染为主（分别为 39%、29%和 17%）。多变量分析确定缺乏患者隔离预防措施（OR：7.500）、使用四联或三联治疗（OR：5.596；OR：5.175）和机械通气（OR：4.926）是与 MDR 细菌获得相关的最重要的临床和流行病学因素。在本 ICU，MDR 细菌患者的归因死亡率约为 12%。
MDR 的发生率高于发达国家。在我们医院，迫切需要实施标准感染控制方案、主动监测 MDR 以及生成关于病原体及其抗菌药物敏感性模式的数据。
