Durdu, B., Kritsotakis, E. orcid.org/0000-0002-9526-3852, Lee, A. orcid.org/0000-0002-9795-3793 et al. (4 more authors) (2018) Temporal trends and patterns in antimicrobial resistant Gram-negative bacteria implicated in intensive care unit-acquired infections: a cohort-based surveillance study in Istanbul, Turkey. Journal of Global Antimicrobial Resistance, 14. pp. 190-196. ISSN 2213-7165
Abstract
Objectives: This study assessed trends and patterns in antimicrobial resistant intensive care unit (ICU)-acquired infections caused by Gram-negative bacteria (GNB) in Istanbul, Turkey.
Methods: Bacterial culture and antibiotic susceptibility data were collected for all GNB causing nosocomial infections in five adult ICUs of a large university hospital during 2012-2015. Multi-resistance patterns were categorised as multidrug (MDR), extensively-drug (XDR) and pandrug (PDR)-resistance. Patterns and trends were assessed using seasonal decomposition and regression analyses.
Results: Of 991 pathogenic GNB recorded, most frequent were Acinetobacter baumannii (35%), Klebsiella species (27%), Pseudomonas aeruginosa (18%), Escherichia coli (7%) and Enterobacter species (4%). The overall infection rate decreased by 41% from 18.4 to 10.9 cases per 1000 patient-days in 2012 compared to 2015 (p<0.001), mostly representing decreases in bloodstream infections and pneumonias by A. baumannii and P. aeruginosa. XDR proportion in A.baumannii increased from 52% in 2012 to 72% in 2015, but only one isolate was colistin-resistant. Multi-resistance patterns remained stable in Klebsiella, with overall XDR and possible PDR proportions of 14% and 2%, respectively. A back-to-susceptibility trend was noted for P. aeruginosa in which the non-MDR proportion increased from 53% in 2012 to 71% in 2015. 88% of E.coli and 40% of Enterobacter isolates were MDR, but none was XDR.
Conclusions: Antimicrobial resistance patterns in pathogenic GNB continuously change over time and may not reflect single-agent resistance trends. The proportionate amount of antimicrobial-resistant GNB may persist despite overall decreasing infection rates. Timely regional surveillance data are thus imperative for optimal infection control.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2018 Elsevier. This is an author produced version of a paper subsequently published in Journal of Global Antimicrobial Resistance. Uploaded in accordance with the publisher's self-archiving policy. Article available under the terms of the CC-BY-NC-ND licence (https://creativecommons.org/licenses/by-nc-nd/4.0/) |
Keywords: | Gram-negative bacteria; Antibiotic resistance; Nosocomial infection; Surveillance; Time trends; Epidemiology; Healthcare epidemiology |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 08 May 2018 12:52 |
Last Modified: | 23 Nov 2020 14:16 |
Status: | Published |
Publisher: | Elsevier |
Refereed: | Yes |
Identification Number: | 10.1016/j.jgar.2018.04.015 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:130460 |
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Licence: CC-BY-NC-ND 4.0