Magnitude and outcomes of lower respiratory tract infections attributed to multi-drug resistant bacteria among critically ill patients at a tertiary center in Jordan.
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Abstract
Objectives: Lower respiratory tract infections related to multidrug-resistant organisms carry a significant morbidity and mortality. In this study we are trying to find the magnitude of this problem among intensive care unit patients admitted to a tertiary university hospital in Jordan and highlight potential associated factors.
Methods: We conducted an observational retrospective study in which we reviewed respiratory and blood cultures of all patients treated in the intensive care unit for a lower respiratory tract infection between January 1, 2021, and October 1, 2022. We investigated all culture positive cases, we investigated the prevalence of multi-drug resistant organisms among culture positive cases, predominating organisms, and compared different groups to look for potential associations and outcomes related to multidrug-resistant organisms.
Results: Out of the 563 patients with lower respiratory tract infections, 208 (37%) were culture positive. A multi-drug resistant organism was isolated from around 81% of the cases (168 out of the 208 patients with positive culture). Multi-drug resistant Acinetobacter baumanii was the predominating organism (isolated from 106 patients, 51% of the culture positive study population and 63% of the MDRO sub-population). The presence of a multi-drug resistant organism was significantly associated with the diagnosis of hospital-acquired pneumonia (P <0.01), use of mechanical ventilation (P <0.01), increased length of hospital stays (P 0.02), and was associated with increased mortality (P <0.01). A. baumannii was also significantly associated with the diagnosis of hospital-acquired pneumonia (P <0.01), use of mechanical ventilation (P <0.01), and increased mortality (P <0.01). Those associations were still significant after conducting multivariate logistic regression.
Conclusions: Our study revealed a significantly high prevalence of multi-drug resistant organism in lower respiratory tract infections among intensive care unit patients at a tertiary center in Jordan. Multi-drug resistant A. baumannii was the most frequently isolated pathogen. It was significantly associated with the diagnosis of hospital-acquired pneumonia, use of mechanical ventilation, and increased mortality. Those findings are alarming and signal the urgent need for implementation of effective infection prevention mechanisms and improved antimicrobial stewardship programs.
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