Active surveillance of adult healthcareassociated infections in intensive care units: resistance and molecular profile in an upper middle-income country

Q3 Medicine

Infectio Pub Date : 2022-08-20 DOI:10.22354/24223794.1077

M. Ochoa-Díaz, Eduardo Santero-Santurino, Amando Flores-Diaz, Eva Camacho-Fernández, María Paulina Osorio-Cortina, Doris Gómez-Camargo

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Abstract

Objective: This study aimed to characterize epidemiological and molecular profile of Healthcare-associated infections [HAI] in 21 intensive care units (ICU) in a city in Colombia. Methods: Descriptive study of prevalence. Adult patients were screened in 21 ICUs for HAIs: VAP, CLABSI; CAUTI and/or SSI. Microbiological and genotypic identification was performed. Results: Prevalence of HAIs was 41.4% (CI 36.9-45.9).VAP 15.8% (CI 12.7-19.4); CLABSI, 13.5% (CI 10.6-16.9); CAUTI, 7.7% (CI 5.5-10.5); and SSI, 4.4% (CI 2.7-6.6). Gram-negative bacteria (71.7%) predominated (P. aeruginosa (19.1%), K. pneumoniae (13.4%) and E. coli (13%)). Pseudomonas spp. 20-30% were resistant to carbapenems and greater than 10% to aztreonam, 3rd- and 4th-generation cephalosporins, and Beta-lactamase inhibitors. In VAP and CLABSI, 30% of Staphylococcus aureus were resistant to oxacillin. In CAUTI, Staphylococcus epidermidis exhibited 100% resistance. In P. aeruginosa resistance gene were blaTEM, blaSHV, and blaCTX-M (15- 32%), KPC (5.7%), and oxacillinases blaOXA-48 (1.8%) and blaOXA-1-40-30 (20-50%). In E. coli, genes qnrB, qnrS and qnrD were identified. In CLABSI, ermC-type (16.7%), aph[2’]’If (7.7%) and ant[4’]-Ia (7.7%) were identified in Staphylococcus aureus. Conclusions: VAP and CLABSI predominate in ICUs evaluated in Colombia due to resistant gram-negative bacteria by ESBL-type resistance genes plasmids, efflux pumps hindering the therapeutic approach.

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重症监护室成人健康护理相关感染的积极监测：一个中等偏上收入国家的耐药性和分子特征

目的：本研究旨在描述哥伦比亚一座城市21个重症监护室（ICU）医疗保健相关感染的流行病学和分子特征。方法：患病率的描述性研究。在21个ICU中对成年患者进行HAIs筛查：VAP、CLBSI；CAUTI和/或SSI。进行微生物学和基因型鉴定。结果：HAI的患病率为41.4%（CI 36.9-45.9），VAP为15.8%（CI 12.7-19.4）；克雷伯氏菌13.5%（ci10.6-16.9）；考蒂7.7%（CI 5.5-10.5）；SSI为4.4%（CI 2.7-6.6）。革兰氏阴性菌（71.7%）占主导地位（铜绿假单胞菌（19.1%）、肺炎克雷伯菌（13.4%）和大肠杆菌（13%））。假单胞菌属（Pseudomonas spp.）20-30%对碳青霉烯类耐药，10%以上对氨曲南、第3代和第4代头孢菌素以及β-内酰胺酶抑制剂耐药。在VAP和CLBSI中，30%的金黄色葡萄球菌对苯唑西林具有耐药性。在CAUTI中，表皮葡萄球菌表现出100%的耐药性。在铜绿假单胞菌中，抗性基因为blaTEM、blaSHV和blaCTX-M（15-32%）、KPC（5.7%），以及草酸杆菌blaOXA-48（1.8%）和blaOXA-40-30（20-50%）。在大肠杆菌中，鉴定了qnrB、qnrS和qnrD基因。在CLBSI中，金黄色葡萄球菌中鉴定出ermC型（16.7%）、aph[2']If型（7.7%）和ant[4']-Ia型（7.70%）。结论：VAP和CLBSI在哥伦比亚评估的ICU中占主导地位，这是由于ESBL型耐药基因质粒的耐药革兰氏阴性菌，外排泵阻碍了治疗方法。

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