Profiles of multidrug-resistant organisms among patients with bacteremia in intensive care units: an international ID-IRI survey
Journal
European Journal of Clinical Microbiology & Infectious Diseases
Date Issued
2021-11
Author(s)
El-Sokkary, Rehab
Uysal, Serhat
Erdem, Hakan
Kullar, Ravina
Pekok, Abdullah Umut
Amer, Fatma
Grgić, Svjetlana
Carevic, Biljana
El-Kholy, Amani
Liskova, Anna
Özdemir, Mehmet
Khan, Ejaz Ahmed
Uygun-Kizmaz, Yesim
Pandak, Nenad
Pandya, Nirav
Arapović, Jurica
Karaali, Rıdvan
Oztoprak, Nefise
Petrov, Michael M
Alabadla, Rami
Alay, Handan
Kholy, Jehan Ali El
Landelle, Caroline
Khedr, Reham
Mamtora, Dhruv
Dragovac, Gorana
Fernandez, Ricardo
Evren, Emine Unal
Raka, Lul
Cascio, Antonio
Dauby, Nicolas
Oncul, Ahsen
Balin, Safak Ozer
Cag, Yasemin
Dirani, Natalia
Dogan, Mustafa
Dumitru, Irina Magdalena
Gad, Maha Ali
Darazam, Ilad Alavi
Naghili, Behrouz
Del Vecchio, Rosa Fontana
Licker, Monica
Marino, Andrea
Akhtar, Nasim
Kamal, Mostafa
Angioni, Goffredo
Medić, Deana
Esmaoğlu, Aliye
Gergely, Szabo Balint
Silva-Pinto, André
Santos, Lurdes
Miftode, Ionela Larisa
Tekin, Recep
Wongsurakiat, Phunsup
Khan, Mumtaz Ali
Kurekci, Yesim
Pilli, Hema Prakash
Miftode, Egidia
Baljic, Rusmir
Vahabolgu, Haluk
Rello, Jordi
DOI
10.1007/s10096-021-04288-1
Abstract
Evaluating trends in antibiotic resistance is a requisite. The study aimed to analyze the profile of multidrug-resistant organisms (MDROs) among hospitalized patients with bacteremia in intensive care units (ICUs) in a large geographical area. This is a 1-month cross-sectional survey for blood-borne pathogens in 57 ICUs from 24 countries with different income levels: lower-middle-income (LMI), upper-middle-income (UMI), and high-income (HI) countries. Multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant isolates were searched. Logistic regression analysis determined resistance predictors among MDROs. Community-acquired infections were comparable to hospital-acquired infections particularly in LMI (94/202; 46.5% vs 108/202; 53.5%). Although MDR (65.1%; 502/771) and XDR (4.9%; 38/771) were common, no pan-drug-resistant isolate was recovered. In total, 32.1% of MDR were Klebsiella pneumoniae, and 55.3% of XDR were Acinetobacter baumannii. The highest MDR and XDR rates were in UMI and LMI, respectively, with no XDR revealed from HI. Predictors of MDR acquisition were male gender (OR, 12.11; 95% CI, 3.025-15.585) and the hospital-acquired origin of bacteremia (OR, 2.643; 95%CI, 1.462-3.894), and XDR acquisition was due to bacteremia in UMI (OR, 3.344; 95%CI, 1.189-5.626) and admission to medical-surgical ICUs (OR, 1.481; 95% CI, 1.076-2.037). We confirm the urgent need to expand stewardship activities to community settings especially in LMI, with more paid attention to the drugs with a higher potential for resistance. Empowering microbiology laboratories and reports to direct prescribing decisions should be prioritized. Supporting stewardship in ICUs, the mixed medical-surgical ones in particular, is warranted.