Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1795
Peer-review started: June 22, 2021
First decision: September 1, 2021
Revised: September 15, 2021
Accepted: January 14, 2022
Article in press: January 14, 2022
Published online: February 26, 2022
There intensive care unit (ICU) patients are critically ill and have low immunity. They will undergo various trauma medical procedures during diagnosis and treatment. The use of high-dose hormones and broad-spectrum antibiotics will increase the incidence of nosocomial infection in ICU patients.
To explore the causes of nosocomial infection of multi drug resistant bacteria in ICU, and to provide basis for the prevention and control of nosocomial infection in ICU.
To provide basis for the prevention and control of nosocomial infection in ICU.
BD PhoenixTM100 automatic bacterial identification and analysis instrument was used for cell identification. Inclusion criteria were: (1) The etiological diagnosis was multidrug-resistant bacterial infection; and (2) Inpatients in the ICU. Exclusion criteria were: (1) Diagnosis of multidrug-resistant bacterial colonization without clinical infection symptoms; (2) Contaminated samples of multidrug-resistant bacteria; and (3) Natural resistant strains. Retrospective analysis was used to investigate and collect patient records and test data. Logistic regression analysis was used to perform univariate and multivariate analyses for independent risk factors for multidrug-resistant infection.
(1) Sample collection: The causative pathogens were mainly collected from sputum in 1139 cases (55.02%), blood in 521 (25.17%), and drainage in 117 (5.65%) (Table 1); (2) Distribution of pathogenic bacterial: Acinetobacter baumannii (A. baumannii) was most common strain, accounting for 35.97% (378/1051) of the total strains, followed by Pseudomonas aeruginosa (P. aeruginosa) (24.74%), Escherichia coli (E. coli) (21.79%) and Klebsiella pneumoniae (K. pneumoniae) (9.42%). Staphylococcus aureus (S. aureus) was the most common Gram-positive bacteria strain with 8.09% (85/1051) (Table 2); (3) Drug-resistance trends and analysis of main pathogens A. baumannii: Resistance rates of A. baumannii to minocycline in 2017 and 2019 were 28.41% and 32.42%, respectively. Resistance rates of this strain to other antimicrobials were > 40% (Table 3). Energy allocation rate to the antimicrobial drug meropenem was 74.6%, and imipenem resistance rate was 75.66% (Table 4); E. coli: Analysis of 2019 data showed 21.4% (5/22) rate of resistance against cefotaxime and 13.6% (3/22) against tobramycin (Table 4). Resistance rate of E. coli against meroxifen was 14.41% (33/229), whereas resistance rate against imipenem was 15.28% (35/229) (Table 3); P. aeruginosa: Analysis of 2016, 2018 and 2019 data showed that a variety of antibiotics showed good antibacterial activity against P. aeruginosa (Table 4). Energy allocation rate of meropenem against P. aeruginosa in the previous 4 years was 20.38% (53/260), whereas imipenem resistance rate was 26.5% (68/260) (Table 3); K. pneumoniae: Analysis of 2019 data showed that K. pneumoniae was 12.5% resistant to cefoperazone/sulbactam (3/27). Drug resistance against K. pneumoniae in 2019 was severe compared with previous years (Table 4). Resistance rate of K. pneumoniae to meropenem in the previous 4 years was 20.20% (20/99), whereas resistance rate of K. pneumoniae to imipenem was 19.9% (19/99) (Table 3); S. aureus: Incidence of methicillin resistance of S. aureus at the time of the study was 64.71% (55/85) (Table 3). And (4) Logistic regression analysis: A ratio of 1:1 was used to analyze risk factors for multidrug-resistant bacterial infection in 208 patients hospitalized in ICU with nosocomial infection. In addition, 208 patients hospitalized at the same time, and with comparable age, sex and symptoms were selected as a control group. Factors with P ≤ 0.05 were included in the logistic regression model to avoid the influence of confounding factors. Logistic regression analysis showed that mechanical ventilation and urine tube intubation were risk factors for infection with multidrug-resistant bacteria (Tables 5 and 6).
Although bacteria have their own drug-resistance mechanism, the primary reason for high incidence of multidrug-resistant bacteria infection in ICUs is inappropriate use of antibiotics, especially abuse of third-generation cephalosporins. Studies have reported that nosocomial infection in ICU patients is a major source of mortality. The purpose of this study was to explore and analyze the main pathogens of ICU nosocomial infections and their drug resistance. The study reports on main pathogenic bacteria of nosocomial infection and corresponding mechanism of drug resistance in the ICU at a specific time, and analyzed drug resistance of pathogenic bacteria after use of antibiotics in the same period.
Logistic analysis results showed that mechanical ventilation and urinary tube intubation were risk factors for infections caused by multidrug-resistant bacteria. This finding implies that our medical staff should carefully consider the necessity before performing the above procedures, to reduce infections caused by multidrug-resistant bacteria. Mechanical ventilation, urinary catheterization and other invasive procedures increase point of entry for pathogens thus increasing resistance level of multi-drug-resistant bacteria. Therefore, the important task of preventing and controlling MDRO infection in ICU is to improve the prevention and control measures as soon as possible in the face of the increasing rate of multidrug-resistant infection in the world.