| Popis: |
Background: Patients admitted to intensive care units (ICU) are at risk of Gram-negative bacteria (GNB) infections, especially those caused by multidrug-resistant (MDR) isolates, increasing morbidity, mortality, and increased healthcare costs. However, epidemiological surveillance data on MDR bacteria to inform infection prevention and control (IPCs) interventions is limited in our study setting. Here we assessed the prevalence and factors associated with GNB infections in ICU- patients admitted in our study setting. Methods: This was a hospital-based cross-sectional study among patients admitted to the ICU at the Nairobi West Hospital, Kenya, between January and October 2022. A total of 162 patients were recruited, excluding those hospitalized for less than 48 hours and declining consent. We collected the participants' demographics and clinical data by case report form. Samples were collected and transported to the hospital microbiology laboratory in a cool box and processed, within 2 hours, by standard bacteriological and automated methods. Results: The prevalence of GNB infections was 55.6%, predominated by urinary tract infections (UTIs). We recovered 13 GNB types, with Escherichia coli (33.3%) and Klebsiella pneumoniae (31.1%) as the most common isolates. Factors associated with GNB infections were a history of antibiotic use (aOR = 4.23, p =0.001), nasogastric tube use (NGT, aOR = 3.04, p = 0.013), respiratory tract (RT, aOR = 5.3, p= 0.005) and cardiovascular (CV, aOR = 5.7, p = 0.024 conditions. About 92% of the GNB isolates were MDR, predominately Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Conclusion: We report a high prevalence of MDR-GNB infections, predominated by UTI, in ICU, where patients with a history of antibiotic use, using the NGT, and having RT and CV conditions were at increased risk. In our study setting, improving ICU patient management warrants strict adherence to IPC policies and implementation of antimicrobial stewardship programs in line with the global and national antimicrobial action plans. |
