Althaqafi Abdulhakeem, Yaseen Muhammad, Farahat Fayssal, Munshi Adeeb, Al-Amri Abdulfattah, Essack Sabiha Y
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Infectious Diseases, King Abdullah International Medical Research Center, Jeddah, SAU.
Cureus. 2023 Apr 8;15(4):e37291. doi: 10.7759/cureus.37291. eCollection 2023 Apr.
Background The increase in the incidence of multidrug-resistant (MDR) organisms especially Gram-negative bacteria (GNB) in healthcare facilities is a serious cause of concern. This study identified risk factors for the infection with these MDR GNB, such as , and to inform healthcare workers about strategies for their containment. Methods A case-control study was carried out at a tertiary care hospital where 100 patients with healthcare-associated infections (infections arising 48 hours after admission) caused by MDR GNB were compared with two control groups, i.e., 100 patients with healthcare-associated infections caused by non-MDR GNB (not meeting the criteria of MDR) and 100 patients without infection caused by GNB. MDR bacteria were defined as the ones that were non-susceptible to at least one antibiotic in three or more classes of antibiotics. The data were analyzed using descriptive statistics (frequency and percentage of categorical variables). Multivariate regression analysis was undertaken to identify significant predictors of MDR GNB. Odds ratios with 95% confidence intervals were calculated, and the level of significance was determined at p-value < 0.05. Results A total of 388 organisms were isolated during four months (January-April 2015) from 332 patients. Fifty-six (17%) of the patients were infected with more than one organism. Among the MDR bacteria, the most dominant MDR organism was (38%), followed by (31%), (20%), and (11%). Among the non-MDR organisms, the most dominant was (47%), followed by (18%), and (3%). Patients with MDR organisms compared with the first control group (patients with non-MDR organisms) showed that prior antibiotic use (p-value: 0.001), intensive care unit (ICU) admission (p-value: 0.001), and indwelling medical devices (p-value: 0.005) were significant risk factors for MDR infections. It was also found that the risk factors for MDR GNB infection were the same in the second control group (patients without infection): prior antibiotic use (p-value: 0.002), ICU admission (p-value: 0.001), and indwelling medical devices (p-value: 0.03). Based on the comparison of the two control groups, prolonged hospital stays of more than five days (p-value: 0.001), immunosuppressive therapy (p-value: 0.02), and over 60 years of age (p-value: 0.02) were significant risk factors for non-MDR infection. Conclusion The risk factors identified in our study provide guidance to healthcare workers for the prevention and containment of MDR GNB.
医疗机构中多重耐药（MDR）微生物尤其是革兰氏阴性菌（GNB）的发病率上升是一个严重的问题。本研究确定了这些多重耐药革兰氏阴性菌感染的风险因素，如 、 和 ，以告知医护人员控制这些风险因素的策略。方法：在一家三级护理医院进行了一项病例对照研究，将100例由多重耐药革兰氏阴性菌引起的医疗相关感染（入院48小时后发生的感染）患者与两个对照组进行比较，即100例由非多重耐药革兰氏阴性菌（不符合多重耐药标准）引起的医疗相关感染患者和100例未感染革兰氏阴性菌的患者。多重耐药菌被定义为对三类或更多类抗生素中的至少一种抗生素不敏感的细菌。使用描述性统计（分类变量的频率和百分比）对数据进行分析。进行多变量回归分析以确定多重耐药革兰氏阴性菌的显著预测因素。计算95%置信区间的比值比，并将显著性水平确定为p值<0.05。结果：在四个月（2015年1月至4月）期间，从332例患者中总共分离出388种微生物。56例（17%）患者感染了不止一种微生物。在多重耐药菌中，最主要的多重耐药菌是 （38%），其次是 （31%）、 （20%）和 （11%）。在非多重耐药菌中，最主要的是 （47%），其次是 （18%）和 （3%）。与第一个对照组（非多重耐药菌患者）相比，多重耐药菌患者显示先前使用抗生素（p值：0.001）、入住重症监护病房（ICU）（p值：0.001）和留置医疗设备（p值：0.005）是多重耐药感染的显著风险因素。还发现，在第二个对照组（未感染患者）中，多重耐药革兰氏阴性菌感染的风险因素相同：先前使用抗生素（p值：0.002）、入住ICU（p值：0.001）和留置医疗设备（p值：0.03）。基于两个对照组的比较，住院时间延长超过五天（p值：0.001）、免疫抑制治疗（p值：0.02）和60岁以上（p值：0.02）是非多重耐药感染的显著风险因素。结论：我们研究中确定的风险因素为医护人员预防和控制多重耐药革兰氏阴性菌提供了指导。
