Kipsang Fred, Munyiva Jeniffer, Menza Nelson, Musyoki Abednego
Department of Biomedical Sciences, Kabarak University, P.O. Private Bag 20157, Nakuru, Kenya.
Department of Laboratory Medicine, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya.
IJID Reg. 2023 Oct 25;9:111-116. doi: 10.1016/j.ijregi.2023.10.007. eCollection 2023 Dec.
Multidrug-resistant (MDR) (AB), especially carbapenem-resistant (CR) strains, presents a significant challenge in intensive care units (ICUs) but surveillance data in many resource-constrained countries is inadequate. Here, we determined the prevalence of MDRAB and risk factors for infection and mortality in ICU-admitted patients.
A cross-sectional study among 132 consecutive patients between July 2019 and July 2020, with infected patients followed for 30 days from sample collection to ICU discharge/death. Blood, urine, and tracheal aspirate samples were processed following the standard bacteriological procedures. Isolate identity and antimicrobial susceptibility were elucidated by VITEK 2 Compact system.
The prevalence of MDRAB was 22.7% (30/132), mostly from urine samples (12.1%, 16/132), and dominated by CRAB (83.3%) that were colistin-nonresistant and exhibited high multiple antibiotic resistance indices, ranging from 0.64-0.91. Risk factors for infection were occupation (adjusted odds ratio = 4.41, = 0.016) and interhospital referral status (adjusted odds ratio = 0.14, = 0.001). ICU mortality was 20% (6/30).
Our findings underpin the need for strict adherence to and evaluation of infection prevention and control, and continuous surveillance of CRAB in ICU, especially among the risk groups, in the current study setting and beyond.
多重耐药鲍曼不动杆菌（MDRAB），尤其是耐碳青霉烯类鲍曼不动杆菌（CR）菌株，给重症监护病房（ICU）带来了重大挑战，但许多资源有限国家的监测数据不足。在此，我们确定了入住ICU患者中MDRAB的流行率以及感染和死亡的危险因素。
对2019年7月至2020年7月期间连续收治的132例患者进行横断面研究，感染患者从样本采集到ICU出院/死亡随访30天。血液、尿液和气管吸出物样本按照标准细菌学程序进行处理。通过VITEK 2 Compact系统鉴定分离株身份并确定其抗菌药敏性。
MDRAB的流行率为22.7%（30/132），大多来自尿液样本（12.1%，16/132），以耐碳青霉烯类鲍曼不动杆菌（CRAB）为主（83.3%），这些菌株对多粘菌素不耐药且表现出较高的多重耐药指数，范围为0.64 - 0.91。感染的危险因素包括职业（调整优势比 = 4.41，P = 0.016）和院际转诊状态（调整优势比 = 0.14，P = 0.001）。ICU死亡率为20%（6/30）。
我们的研究结果强调了在当前研究环境及其他环境中，ICU需要严格遵守和评估感染预防与控制措施，并持续监测CRAB，尤其是在风险群体中。
