Epidemiology of MDR Infections in the ICU: Comparing Outcomes in Patients with and Without Prior Antibiotic Exposure
DOI:
https://doi.org/10.63682/jns.v14i32S.7916Keywords:
infections, ICU outcomes, prior antibiotic exposure, antimicrobial resistance, patient mortalityAbstract
Background: The significant challenge in Intensive Care Units (ICUs) are so-called multidrug-resistant (MDR) infections, which can cause higher morbidity, longer hospitals stays and high emission costs. The impact of prior antibiotic exposure as a risk factor of the development of MDR organisms is widely recognized but patient outcome is still controversial.
Objective: The trial was designed to compare the clinical outcomes of patients with MDR infection in the ICU according to the history of previous exposure to antibiotics.
Methods: The study was an observational study conducted over a period of 8 months; January-August 2023, in Medical, and Surgical ICU units of Mayo Hospital, Lahore. Three hundred and twenty patient developing culture-confirmed MDR infections 48 hours or later of ICU admission were included. They categorized patients into two groups depending on recorded system antibiotics utilization within 90 days prior ICU. Clinical/demographic parameters have been examined and multivariate logistic regression was done to assess independent predictors of mortality.
Result: A total of 176/320 (55.0%) patients had the history of previous antibiotic exposure. The incidences of diabetes (48.9% vs. 36.1%, p=.3, CKD (35.2% vs. 24.3%, p=.2, thrombocytopenia (30.7%vs.18.8%, p=0.01) and prolonged ICU stay (10 vs. 7 days, p=4) were high among these patients. Yet, the previous exposure to antibiotics was not an independent predictor of death (OR=110p=058). Rather, lengthy mechanical ventilation, prolonged ICU stay and indwelling lines were substantial predictors.
Conclusion: While prior antibiotic exposure is associated with increased morbidity and longer hospital stays, it does not independently increase mortality risk in ICU patients with MDR infections.
Downloads
Metrics
References
Fernández-Martínez, N. F., Cárcel-Fernández, S., De la Fuente-Martos, C., Ruiz-Montero, R., Guzmán-Herrador, B. R., León-López, R., ... Salcedo-Leal, I. (2022). Risk factors for multidrug-resistant gram-negative bacteria carriage upon admission to the intensive care unit. International Journal of Environmental Research and Public Health, 19(3), 1039. https://doi.org/10.3390/ijerph19031039
Schinas, G., Polyzou, E., Spernovasilis, N., Gogos, C., Dimopoulos, G., & Akinosoglou, K. (2023). Preventing multidrug-resistant bacterial transmission in the intensive care unit with a comprehensive approach: A policymaking manual. Antibiotics, 12(8), 1255. https://doi.org/10.3390/antibiotics12081255
Assefa, M., & Amare, A. (2022). Biofilm-associated multi-drug resistance in hospital-acquired infections: A review. Infection and Drug Resistance, 15, 5061–5068. https://doi.org/10.2147/IDR.S370373
Teng, J., Imani, S., Zhou, A., Zhao, Y., Du, L., Deng, S., ... Wang, Q. (2023). Combatting resistance: Understanding multi-drug resistant pathogens in intensive care units. Biomedicine & Pharmacotherapy, 167, 115564. https://doi.org/10.1016/j.biopha.2023.115564
Xi, Y., Zhang, W., Qiao, R. J., & Tang, J. (2022). Risk factors for multidrug-resistant tuberculosis: A worldwide systematic review and meta-analysis. PLOS ONE, 17(6), e0270003. https://doi.org/10.1371/journal.pone.0270003
Muteeb, G., Rehman, M. T., Shahwan, M., & Aatif, M. (2023). Origin of antibiotics and antibiotic resistance, and their impacts on drug development: A narrative review. Pharmaceuticals, 16(11), 1615. https://doi.org/10.3390/ph16111615
Sulis, G., Sayood, S., & Gandra, S. (2022). Antimicrobial resistance in low-and middle-income countries: Current status and future directions. Expert Review of Anti-infective Therapy, 20(2), 147–160. https://doi.org/10.1080/14787210.2022.1984764
Rony, M. K. K., Sharmi, P. D., & Alamgir, H. M. (2023). Addressing antimicrobial resistance in low and middle-income countries: Overcoming challenges and implementing effective strategies. Environmental Science and Pollution Research, 30(45), 101896–101902. https://doi.org/10.1007/s11356-023-29308-z
Fatima, Z., Purkait, D., Rehman, S., Rai, S., & Hameed, S. (2023). Multidrug resistance: A threat to antibiotic era. In Biological and Environmental Hazards, Risks, and Disasters (pp. 197–220). Elsevier. https://doi.org/10.1016/B978-0-323-89990-4.00016-6
Catalano, A., Iacopetta, D., Ceramella, J., Scumaci, D., Giuzio, F., Saturnino, C., ... Sinicropi, M. S. (2022). Multidrug resistance (MDR): A widespread phenomenon in pharmacological therapies. Molecules, 27(3), 616. https://doi.org/10.3390/molecules27030616
Bassetti, S., Tschudin-Sutter, S., Egli, A., & Osthoff, M. (2022). Optimizing antibiotic therapies to reduce the risk of bacterial resistance. European Journal of Internal Medicine, 99, 7–12. https://doi.org/10.1016/j.ejim.2021.10.020
Kalin, G., Alp, E., Chouaikhi, A., & Roger, C. (2023). Antimicrobial multidrug resistance: Clinical implications for infection management in critically ill patients. Microorganisms, 11(10), 2575. https://doi.org/10.3390/microorganisms11102575
Roy, S., Chowdhury, G., Mukhopadhyay, A. K., Dutta, S., & Basu, S. (2022). Convergence of biofilm formation and antibiotic resistance in Acinetobacter baumannii infection. Frontiers in Medicine, 9, 793615. https://doi.org/10.3389/fmed.2022.793615
Assefa, M. (2022). Multi-drug resistant gram-negative bacterial pneumonia: Etiology, risk factors, and drug resistance patterns. Pneumonia, 14(1), 4. https://doi.org/10.1186/s41479-022-00101-2
Abushanab, D., Nasr, Z. G., & Al-Badriyeh, D. (2022). Efficacy and safety of colistin versus tigecycline for multi-drug-resistant and extensively drug-resistant gram-negative pathogens—A meta-analysis. Antibiotics, 11(11), 1630. https://doi.org/10.3390/antibiotics11111630
Adeniji, O. O., Nontongana, N., Okoh, J. C., & Okoh, A. I. (2022). The potential of antibiotics and nanomaterial combinations as therapeutic strategies in the management of multidrug-resistant infections: A review. International Journal of Molecular Sciences, 23(23), 15038. https://doi.org/10.3390/ijms232315038
Ceccarelli, G., Alessandri, F., Moretti, S., Borsetti, A., Maggiorella, M. T., Fabris, S., ... d'Ettorre, G. (2022). Clinical impact of colonization with carbapenem-resistant gram-negative bacteria in critically ill patients admitted for severe trauma. Pathogens, 11(11), 1295. https://doi.org/10.3390/pathogens11111295
Alnimr, A. (2023). Antimicrobial resistance in ventilator-associated pneumonia: Predictive microbiology and evidence-based therapy. Infectious Diseases and Therapy, 12(6), 1527–1552. https://doi.org/10.1007/s40121-023-00810-w
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
