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ANTIBIOTIC RESISTANCE CHARACTERISTICS OF PATHOGENS CAUSING NOSOCOMIAL INFECTIONS AND MORTALITY RISK FACTORS IN THE INTENSIVE CARE UNIT AT BACH MAI HOSPITAL
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Abstract
Objective: Description of antibiotic resistance characteristics of nosocomial infections and risk factors for mortality in the intensive care unit at Bach Mai hospital. Subject and method: A prospective, cross-sectional description of 970 patients treated for more than 48 hours at the Intensive Care Unit of Bach Mai Hospital (August 2019-July 2020). Result: The rate of nosocomial infections was 14%, the most common bacterial etiology is A.Baumannii (28.2%), K.pneumoniae (19.7%), P.aeruginosa (6.3%), common fungal etiology especially Candida Albicans (8.6%). 95% of A.Baumannii, K.pneumoniae, P.aeruginosa were resistant to Cephalosporin, Quinolone antibiotics, 70%-96% resistant to Carbapenem group, the colistin group had the lowest resistance rate (A.Baumannii 0%, K.pneumoniae 23%, P.aeruginosa 25%). With Aminoglycoside group, K.pneumoniae was less resistant (32%) than strains A.Baumannii (88%) and P.aeruginosa (60%). 970 study patients had a mortality rate of 25% (243/970), the mortality from nosocomial infections was 33,6% (46/137). Independent factors that increase mortality are immunosuppression (OR 2,3; 95% CI 1,4-3,86, p < 0,01), mechanical ventilation (OR 14,6, 95% CI 5,4-39,6; p <0,01), catheter (OR 1,83; 95% CI 1,2-2,7; p < 0,01), urinary catheter (OR 2,0; 95% CI 1,2- 3,8; p <0,05), nosocomial infections (OR 1,63; 95%CI 1,1- 2,4; p<0,05), nosocomial infections caused of K.pneumoniae (OR 2,27; 95% CI 1,1- 4,6; p<0,05), A.Baumanii (OR 1,76; 95% CI 1,1-3,35; p < 0,05). Conclusion: The most common causes of nosocomial infections were A.Baumannii, K.pneumoniae, P.aeruginosa, these bacteria were 80% - 96% resistant to Carbapenem antibiotic group, low rate of resistance to Colistin group. Independent risk factors contributing to the increased in mortality were immunosuppression, invasive procedures, and multidrug-resistant bacterial infections.
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Keywords
Nosocomial infections, bacteria, antibiotic resistance, Mortality
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