Prevalence of Multi-Drug Resistant Bacteria Isolated from Patients Admitted to the Intensive Care Unit in Tehran, Iran: a Five-Year Prospective Study- 2019-2023
Abstract
Background: The study aims to identify bacterial agents and study the prevalence of pathogenic bacteria isolated from patients admitted to the Intensive Care Unit, as well as recognize factors affecting nosocomial infection that can lead to control and treatment of these infections.
Methods: This study was conducted in the Intensive Care Unit of Baqiyatallah Hospital in Tehran. Totally 738 samples were obtained from patients with a bacterial infection were included in this study. Patient information, including age, gender, type of clinical sample, susceptibility testing, year of hospitalization in to the Intensive Care Unit, and the prevalence of isolated bacteria, was analyzed. Results: The findings of this study revealed that Acinetobacter, Pseudomonas aeruginosa, and Staphylococcus aureus had the highest and Escherichia coli, Enterobacter, and Streptococci had the lowest prevalence in the to the Intensive Care Unit isolates. Gram-negative bacteria were responsible for most nosocomial infections in the Intensive Care Unit. The rate of nosocomial infections in the Intensive Care Unit had a constant incidence in the recorded years. The rate of nosocomial infections was higher in the male patients than female, with a higher average year of age. Also, the results showed that most isolates were multiple drug resistant.
Conclusion: The high rate of nosocomial infections in to the Intensive Care Unit belonged to respiratory infections. Factors such as intubation and elderly age are associated with the type of infection. Bacterial isolates had a high level of resistance to most antibiotics. Therefore, periodic antibacterial sensitivity assessment could help optimize empirical antibiotic therapy against to the Intensive Care Unit acquired infections.
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14. Amini M, Javanmard A, Davati A, et al. Bacterial colonization in tracheal tubes of ICU patients. Iran J Pathology 2009; 4(3):123-7.
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26. Thanni LO, Osinupebi OA, Deji-Agboola M. Prevalence of bacterial pathogens in infected wounds in a tertiary hospital, 1995-2001: any change in trend? J Natl Med Assoc 2003; 95(12):1189-95.
27. Harbarth S, Ruef C, Francioli P, et al. Nosocomial infections in Swiss university hospitals: a multi-centre survey and review of the published experience. Swiss-Noso Network. Schweiz Med Wochenschr 1999; 129(42):1521-8.
28. Larypoor M, Frsad S. Evaluation of nosocomial infections in one of hospitals of Qom, 2008. IJMM 2011; 5(3):7-17.
29. Mohammadimehr M, Feizabadi MM, Bahadori O, et al. Study of prevalence of gram-negative bacteria caused nosocomial infections in ICU in Besat hospital in Tehran and detection of their antibiotic resistance pattern-year 2007. IJMM 2009; 3(2):47-54.
30. Lavakhamseh H, Shakib P, Rouhi S, et al. A survey on the prevalence and antibiotic sensitivity of nosocomial infections in the besat hospital, Sanandaj, Iran. J Nos Infec 2014; 1(2):1-8.
31. Zolldann D, Haefner H, Poetter C, et al. Assessment of a selective surveillance method for detecting nosocomial infections in patients in the intensive care department. Am J Infect Control 2003; 31(5):261-5.
32. Sahm DF, Brown NP, Draghi DC, et al. Tracking resistance among bacterial respiratory tract pathogens: summary of findings of the TRUST Surveillance Initiative, 2001-2005. Postgraduate medicine 2008; 120(1):8-15.
33. Hoban DJ, Bouchillon SK, Hawser SP, et al. Trends in the frequency of multiple drug-resistant Enterobacteriaceae and their susceptibility to ertapenem, imipenem, and other antimicrobial agents: data from the Study for Monitoring Antimicrobial Resistance Trends 2002 to 2007. Diagn Microbiol Infect Dis 2010; 66(1):78-86.
34. Meng X, Dong M, Wang DI, et al. Antimicrobial susceptibility patterns of clinical isolates of gram-negative bacteria obtained from intensive care units in a tertiary hospital in Beijing, China. J Chemother 2011; 23(4):207-10.
35. Bergmans DC, Bonten MJ, Gaillard CA, et al. Indications for antibiotic use in ICU patients: a one-year prospective surveillance. J Antimicrob Chemother 1997; 39(4):527-35.
36. Emmerson M. Antibiotic usage and prescribing policies in the intensive care unit. Intensive Care Med 2000; 26(1):S26-30.
37. Ebrahimzadeh MA, Shokrzadeh M, Ramezani A. Utilization pattern of antibiotics in different wards of specialized Sari Emam University Hospital in Iran. Pak J Biol Sci 2008; 11(2): 275-9.
2. Janbakhsh A, Naghipour A, Mohseni Afshar Z, et al. The prevalence of nosocomial infections in Imam Reza Hospital of Kermanshah, Iran, during 2019–2020. J Kermanshah Univ Med Sci 2023; 27:e138126.
3. Taj A, Shamim A, Khanday SB, et al. Prevalence of common nosocomial organisms in surgical intensive care unit in North India: A hospital-based study. Int J Crit Illn Inj Sci 2018; 8(2):78-82.
4. Golli AL, Cristea OM, Zlatian O, et al. Prevalence of multidrug-resistant pathogens causing bloodstream infections in an intensive care unit. Infect Drug Resist 2022:5981-92.
5. Zlatian O, Balasoiu A, Balasoiu M, et al. Antimicrobial resistance in bacterial pathogens among hospitalised patients with severe invasive infections. Exp Ther Med 2018; 16(6):4499-510.
6. Martins APS, da Mata CPSM, Dos Santos UR, et al. Association between multidrug-resistant bacteria and outcomes in intensive care unit patients: a non-interventional study. F Pub H 2024; 11:1297350.
7. Unal S, Garcia-Rodriguez JA. Activity of meropenem and comparators against Pseudomonas aeruginosa and Acinetobacter spp. isolated in the MYSTIC Program, 2002-2004. Diagn Microbiol Infect Dis 2005; 53(4):265-71.
8. Hashemian M, Kazemian H, Kaviar VH, et al. Nosocomial infections and antimicrobial susceptibility patterns among patients admitted to intensive care unit of Imam Khomeini hospital in Ilam, Iran. Mol Biol Rep 2023; 50(7): 5565-74.
9. Khan JZ, Ismail M, Ullah R, et al. Increased burden of MDR bacterial infections; reflection from an antibiogram of ICUs of a tertiary care hospital. J Infect Dev Ctries 2023; 17(07):994-8.
10. Kulvatunyou N, Boonbarwornrattanakul A, Soonthornkit Y, et al. Incidence of ventilator-associated pneumonia (VAP) after the institution of an educational program on VAP prevention. J Med Assoc Thai 2007; 90(1):89-95.
11. Wayne P. Clinical and Laboratory Standards Institute (CLSI) performance standards for antimicrobial disk diffusion susceptibility tests 19th ed. approved standard. CLSI document M100-S19 2009; 29.
12. Lim C, Takahashi E, Hongsuwan M, et al. Epidemiology and burden of multidrug-resistant bacterial infection in a developing country. Elife 2016; 5:1-18.
13. Obeidat N, Jawdat F, Al-Bakri AG, et al. Major biologic characteristics of Acinetobacter baumannii isolates from hospital environmental and patients' respiratory tract sources. Am J Infect Control 2014; 42(4):401-4.
14. Amini M, Javanmard A, Davati A, et al. Bacterial colonization in tracheal tubes of ICU patients. Iran J Pathology 2009; 4(3):123-7.
15. Vincent JL. Nosocomial infections in adult intensive-care units. Lancet 2003; 361(9374):2068-77.
16. Habibian R. Changes of trend of antibiotic susceptibility in isolated bacteria from culture of ICU patients of Shahrekord Ayatollah Kashanani Hospital, IR Iran. JSUMS 2012; 14.
17. Shojaei S, Rahimi T, Amini M, et al. Survey of Nosocomial Infections in Patients Admitted to Nekoei Hospital of Qom City in 2012, Iran. Qom Uni Med Sci J 2015; 9:64-73.
18. Orrett FA. Nosocomial infections in an intensive care unit in a private hospital. West Indian Med J 2002; 51(1):21-4.
19. Mendes C, Oplustil C, Sakagami E, et al. Antimicrobial susceptibility in intensive care units: MYSTIC Program Brazil 2002. Braz J Infect Dis 2005; 9(1):44-51.
20. Malani PN. Mandell, Douglas. Bennett’s principles and practice of infectious diseases. JAMA 2010; 304(18):2067-71.
21. Seth AK, Geringer MR, Hong SJ, et al. Comparative analysis of single-species and polybacterial wound biofilms using a quantitative, in vivo, rabbit ear model. PLosOne 2012; 7(8):e42897.
22. Rhoads DD, Cox SB, Rees EJ, et al. Clinical identification of bacteria in human chronic wound infections: culturing vs. 16S ribosomal DNA sequencing. BMC Infect Dis 2012; 12:321.
23. Mama M, Abdissa A, Sewunet T. Antimicrobial susceptibility pattern of bacterial isolates from wound infection and their sensitivity to alternative topical agents at Jimma University Specialized Hospital, South-West Ethiopia. Ann Clin Microbiol Antimicrob 2014; 13:14.
24. Rolston KV, Bodey GP, Safdar A. Polymicrobial infection in patients with cancer: an underappreciated and underreported entity. Clin Infect Dis 2007; 45(2):228-33.
25. Choopani A, Rafati H. Prevalence of Staphylococcus aureus strains isolated from wound infection and drug sensitivity pattern, Tehran-Iran (2006-07). J Gorgan Uni Med Sci 2012; 14(3):135-40.
26. Thanni LO, Osinupebi OA, Deji-Agboola M. Prevalence of bacterial pathogens in infected wounds in a tertiary hospital, 1995-2001: any change in trend? J Natl Med Assoc 2003; 95(12):1189-95.
27. Harbarth S, Ruef C, Francioli P, et al. Nosocomial infections in Swiss university hospitals: a multi-centre survey and review of the published experience. Swiss-Noso Network. Schweiz Med Wochenschr 1999; 129(42):1521-8.
28. Larypoor M, Frsad S. Evaluation of nosocomial infections in one of hospitals of Qom, 2008. IJMM 2011; 5(3):7-17.
29. Mohammadimehr M, Feizabadi MM, Bahadori O, et al. Study of prevalence of gram-negative bacteria caused nosocomial infections in ICU in Besat hospital in Tehran and detection of their antibiotic resistance pattern-year 2007. IJMM 2009; 3(2):47-54.
30. Lavakhamseh H, Shakib P, Rouhi S, et al. A survey on the prevalence and antibiotic sensitivity of nosocomial infections in the besat hospital, Sanandaj, Iran. J Nos Infec 2014; 1(2):1-8.
31. Zolldann D, Haefner H, Poetter C, et al. Assessment of a selective surveillance method for detecting nosocomial infections in patients in the intensive care department. Am J Infect Control 2003; 31(5):261-5.
32. Sahm DF, Brown NP, Draghi DC, et al. Tracking resistance among bacterial respiratory tract pathogens: summary of findings of the TRUST Surveillance Initiative, 2001-2005. Postgraduate medicine 2008; 120(1):8-15.
33. Hoban DJ, Bouchillon SK, Hawser SP, et al. Trends in the frequency of multiple drug-resistant Enterobacteriaceae and their susceptibility to ertapenem, imipenem, and other antimicrobial agents: data from the Study for Monitoring Antimicrobial Resistance Trends 2002 to 2007. Diagn Microbiol Infect Dis 2010; 66(1):78-86.
34. Meng X, Dong M, Wang DI, et al. Antimicrobial susceptibility patterns of clinical isolates of gram-negative bacteria obtained from intensive care units in a tertiary hospital in Beijing, China. J Chemother 2011; 23(4):207-10.
35. Bergmans DC, Bonten MJ, Gaillard CA, et al. Indications for antibiotic use in ICU patients: a one-year prospective surveillance. J Antimicrob Chemother 1997; 39(4):527-35.
36. Emmerson M. Antibiotic usage and prescribing policies in the intensive care unit. Intensive Care Med 2000; 26(1):S26-30.
37. Ebrahimzadeh MA, Shokrzadeh M, Ramezani A. Utilization pattern of antibiotics in different wards of specialized Sari Emam University Hospital in Iran. Pak J Biol Sci 2008; 11(2): 275-9.
| Issue | Vol 13 No 4 (2025) | |
| Section | Original Articles | |
| Keywords | ||
| Bacterial infections Drug resistance Intensive care unit Nosocomial infections. | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ahmadi A, Khani S, Imani Fooladi AA. Prevalence of Multi-Drug Resistant Bacteria Isolated from Patients Admitted to the Intensive Care Unit in Tehran, Iran: a Five-Year Prospective Study- 2019-2023. J Med Bacteriol. 2025;13(4):67-74.
