Kilinc Metin
Department of Anesthesiology and Reanimation, Faculty of Medicine, Mardin Artuklu University, Mardin 47200, Turkey.
Antibiotics (Basel). 2025 Mar 11;14(3):290. doi: 10.3390/antibiotics14030290.
This study aimed to analyze the antibiotic resistance patterns of microorganisms isolated from intensive care unit (ICU) patients and evaluate their impact on mortality and length of ICU stay. Given the increasing prevalence of multidrug-resistant (MDR) pathogens in critically ill patients, understanding their resistance profiles is crucial for optimizing empirical antibiotic therapy and improving patient outcomes.
This retrospective study included 237 ICU patients admitted between 1 July 2022, and 1 January 2024. The initial culture growth results from blood and urine samples were analyzed. Microorganism identification was performed using VITEK 2 Compact and conventional bacteriological methods, while antibiotic susceptibility testing followed CLSI 2022 and EUCAST 2022 guidelines.
A total of 237 ICU patients were included in this study. The most frequently isolated microorganisms were () (44.3%), () (35.0%), and () (25.3%), () (31.2%) being the most resistant pathogen. Among Gram-positive bacteria, () (12.2%) and vancomycin-resistant enterococci () (21.5%) were the most frequently identified multidrug-resistant (MDR) pathogens. Regarding antimicrobial resistance, carbapenem resistance was highest in (55%), followed by (40%) and (30%). Additionally, ESBL-producing (43.2%) and (38.5%), as well as carbapenemase-producing (18.6%) and (9.2%), were identified as key resistance mechanisms impacting clinical outcomes. Patients with MDR infections had significantly longer ICU stays ( < 0.05) and higher mortality rates. The Kaplan-Meier survival analysis revealed that infections were associated with the highest mortality risk (HR: 4.6, < 0.001), followed by (HR: 3.5, = 0.005) and (HR: 2.8, = 0.01). Among laboratory biomarkers, elevated procalcitonin (≥2 ng/mL, OR: 2.8, = 0.008) and CRP (≥100 mg/L, OR: 2.2, = 0.01) were significantly associated with ICU mortality. Additionally, patients who remained in the ICU for more than seven days had a 1.4-fold increased risk of mortality ( = 0.02), further emphasizing the impact of prolonged hospitalization on adverse outcomes.
MDR pathogens, particularly , , , and , are associated with longer ICU stays and higher mortality rates. Carbapenem, cephalosporin, fluoroquinolone, and aminoglycoside resistance significantly impact clinical outcomes, emphasizing the urgent need for antimicrobial stewardship programs. ESBL, p-AmpC, and carbapenemase-producing further worsen patient outcomes, highlighting the need for early infection control strategies and optimized empirical antibiotic selection. Biomarkers such as procalcitonin and CRP, alongside clinical severity scores, serve as valuable prognostic tools for ICU mortality.
本研究旨在分析从重症监护病房（ICU）患者中分离出的微生物的抗生素耐药模式，并评估其对死亡率和ICU住院时间的影响。鉴于重症患者中多重耐药（MDR）病原体的患病率不断上升，了解其耐药谱对于优化经验性抗生素治疗和改善患者预后至关重要。
这项回顾性研究纳入了2022年7月1日至2024年1月1日期间收治的237例ICU患者。分析了血液和尿液样本的初始培养生长结果。使用VITEK 2 Compact和传统细菌学方法进行微生物鉴定，而抗生素敏感性测试遵循CLSI 2022和EUCAST 2022指南。
本研究共纳入237例ICU患者。最常分离出的微生物是（）（44.3%）、（）（35.0%）和（）（25.3%），（）（31.2%）是最耐药的病原体。在革兰氏阳性菌中，（）（12.2%）和耐万古霉素肠球菌（）（21.5%）是最常鉴定出的多重耐药（MDR）病原体。关于抗菌药物耐药性，碳青霉烯耐药率在（）中最高（55%），其次是（）（40%）和（）（30%）。此外，产超广谱β-内酰胺酶（ESBL）的（）（43.2%）和（）（38.5%），以及产碳青霉烯酶的（）（18.6%）和（）（9.2%），被确定为影响临床结局的关键耐药机制。MDR感染患者的ICU住院时间显著更长（<0.05），死亡率更高。Kaplan-Meier生存分析显示，（）感染与最高的死亡风险相关（HR：4.6，<0.001），其次是（）（HR：3.5，=0.005）和（）（HR：2.8，=0.01）。在实验室生物标志物中，降钙素原升高（≥2 ng/mL，OR：2.8，=0.008）和CRP升高（≥100 mg/L，OR：2.2，=0.01）与ICU死亡率显著相关。此外，在ICU停留超过七天的患者死亡风险增加1.4倍（=0.02），进一步强调了延长住院时间对不良结局的影响。
MDR病原体，特别是（）、（）、（）和（），与更长的ICU住院时间和更高的死亡率相关。碳青霉烯、头孢菌素、氟喹诺酮和氨基糖苷类耐药性显著影响临床结局，强调了对抗菌药物管理计划的迫切需求。产ESBL、p-AmpC和碳青霉烯酶的（）进一步恶化患者结局，突出了早期感染控制策略和优化经验性抗生素选择的必要性。降钙素原和CRP等生物标志物以及临床严重程度评分是ICU死亡率的有价值的预后工具。
