Multidrug-Resistant and Carbapenemase-Producing Gram-Negative Bacteria among Intensive Care Unit Patients in Amhara National Regional State, Ethiopia

Abstract

Antimicrobials are extensively used in patients admitted to intensive care units (ICUs). As a result, the ICU has become a hot spot for multidrug-resistant (MDR) and carbapenemase-producing (CP) Gram-negative bacteria (GNB) infection in hospitals. Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter baumannii are critical priority GNB causing serious infections in ICUs. Therefore, this study aimed to assess the prevalence, antibiotic resistance profile, and associated factors of critical GNB among ICU patients in Amhara National Regional State, Ethiopia. A hospital-based cross-sectional study was conducted. Based on patients' clinical findings, different clinical samples were aseptically collected. Bacterial identification was done using biochemical tests, and antibiotic susceptibility was determined by the Kirby-Bauer disk diffusion method. Modified and simplified carbapenem inactivation methods were used for meropenem-resistant isolates to phenotypically detect carbapenemase production. Six hundred clinical specimens were collected, most of which were blood (94.8%) followed by urine (2.7%), discharge (2.0%), and tracheal aspirates (0.5%). Of these specimens, 148 (24.7%) were culture positive. Overall prevalence rates of MDR (resistance to one or more agents in three or more antibiotic classes) and CP critical GNB were 79.7% and 9.5%, respectively, with 76.3-100% resistance to commonly prescribed antibiotics. Empirical treatment with antibiotics was significantly associated with MDR critical GNB infection (adjusted odds ratio: 6.57, CI: 2.19-19.82). In conclusion, the majority of the isolates showed a higher resistance rate to commonly prescribed antibiotics. These findings urgently call for strengthened antimicrobial stewardship and enhanced infection prevention and control practices in these settings.