الفهرس 
MULI-DRUG RESISTANT ORGANISMSOnly 14 pages are availabe for public view
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Abstract
Increasing rates of MDR bacteria are a worldwide public health problem. Over the past decades there had been a dramatic increase in MDR-Gram-negative and MDR Gram positive organisms, particularly among isolates from ICU patients, international health organizations.
Multi-drug resistant organisms (MDROs) have been divided into three categories depending on their resistance profile: 1. Multi drug resistant organisms (MDROs)—non-susceptible to at least 1 agent in 3 antimicrobial categories; 2. extensively drug-resistant (XDR) organisms—non-susceptible to at least 1 agent in all but 2 or fewer antimicrobial categories and 3. pan drug-resistant (PDR) organisms—non-susceptible to all agents in all antimicrobial categories.
This study was conducted from May 2018 to May 2019 in Respiratory Intensive Care Unit of Alabbassya Chest hospital.
All patients were subjected to Full history taking and thorough clinical examination, Assessment of comorbidities, Full laboratory investigations, Radiological investigation, Culture and sensitivity.
All patients were divided into two groups: patients with MDR organisms and patients without MDR organisms, MDR organisms defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories.
In the present study, 67.7% of cases were males, 58.6% of cases were smokers and 68.7 % of cases had previous hospital admission, Diabetes mellitus was the most frequent comorbidity (25.3 % of patients) and the most frequent comorbidity with MDR. Infective exacerbation of COPD was the most frequent infection (42.4 % of the studied cases), 67.7% of them had type II respiratory failure. 77.8% of cases required mechanical ventilation and mortality occurred in about half of cases.
Gram negative bacteria represented 83.19% of isolates, with K. pneumoniae presenting 50.5% of them. MDR was detected in more than three quarters of the studied cases with K. pneumoniae (57.3%) and Acinetobacter (30.5%) the most frequent. 76.8% of MDR bacteria were sensitive in vitro to colistin antibiotic.
Occurrence of MDR bacterial infection did not correlate to a specific risk factor. There was however, a trend of increased MDR in patients with frequent antibiotic use before hospital admission.
CONCLUSION
I
nfection with MDR pathogens were frequent in patients admitted to respiratory ICU. In the current study Klebsiella and Acintobacter presented the majority of MDR isolates and colistin was the drug which most frequently showed in vitro activity against isolates. Prior use of antibiotics seems to be a significant predisposing factor to development of infection with MDR organisms.
RECOMMENDATIONS
W
idespread infection with MDR organisms especially gram-negative organisms is increasing, and the situation is becoming more serious each day, with growing drug resistance. Difficulties in treatment are hard to manage. Some of these infections may be reduced if prevention programmes are timely and effectively applied. Avoidance of unnecessary antimicrobial treatment, invasive devices, and some other procedures, as well as shortening the length of hospital stay by applying effective treatment for underlying illnesses, may make infections easier to control. Furthermore, good sanitation practices and staff hygiene may also contribute to controlling the threat of infection with MDR organisms.