Antimicrobial resistance pattern in healthcare-associated infections: investigation of in-hospital risk factors

Mohammad Masoud  Emami Meybodi; Abbas Rahimi Foroushani; Masoome Zolfaghari; Alireza Abdollahi; Abbas Alipour; Esmaeil Mohammadnejad; Ehsan  Zare Mehrjardi; Arash Seifi

doi:10.18502/ijm.v13i2.5978

Mohammad Masoud Emami Meybodi Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abbas Rahimi Foroushani Department of Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Masoome Zolfaghari Department of Infectious Diseases, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Alireza Abdollahi Department of Pathology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abbas Alipour Department of Community Medicine, Thalassemia Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
Esmaeil Mohammadnejad Department of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Ehsan Zare Mehrjardi Department of Industrial and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
Arash Seifi Department of Industrial and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran

DOI: https://doi.org/10.18502/ijm.v13i2.5978

Keywords: Drug resistance; Cross infection; Methicillin-resistant Staphylococcus aureus; Vancomycin resistant Enterococci; Klebsiella pneumoniae; Escherichia coli

Abstract

Background and Objectives: Antimicrobial resistance (AMR) is an increasing threat for efficient treatment of infections. Determining the epidemiology of healthcare-associated infections and causative agents in various hospital wards helps appropriate selection of antimicrobial agents.

Materials and Methods: This retrospective study was performed by analyzing antibiograms from March 2017 to March 2018 among patients admitted to the different wards of Imam Khomeini Hospital Complex in Tehran, Iran.

Results: Among 2440 hospital acquired infections, 59.3% were Gram-negative bacilli: E. coli (n = 469, 22.2%), K. pneumoniae (n = 457, 21.7%), Acinetobacter spp. (n = 282, 13.4%), P. aeruginosa (n = 139, 6.6%) and important Gram-positive bacteria were Enterococcus spp. (n = 216, 10.2%), S. aureus (n = 148, 7%), S. epidermidis (n = 118, 5.6). Generally, there was a high antimicrobial resistance in bacterial isolates in this study. Methicillin resistant Staphylococcus aureus (MRSA) was 56.3 % and MRSE 62.9 %. Vancomycin resistant enterococci (VRE) was 60.7%. K. pneumoniae- ESBL was 79.6% and its resistance to carbapenem was 38.4%. E. coli-ESBL was 42% and its resistance to carbapenems was 2.3%. P. aeruginosa resistance to ceftazidime was 74.4%, to fluroquinolones 63.3%, to aminoglycosides 64.8%, to piperacillin tazobactam 47.6% and to carbapenems 62.1%. Acinetobacter baumannii resistance to ceftazidime was 98.7%, to fluroquinolones 97%, to aminoglycosides 95.9%, to ampicillin sulbactam 84%, to carbapenems 96.4% and to colistin 4%.

Conclusion: The study revealed an alarming rate of resistance to the commonly used antimicrobial agents used in treating HAIs. Also the relationship between AMR and some risk factors and thus taking steps towards controlling them have been shown.