Bacterial Profile and Their Antibiotic Resistance Patterns from Blood Culture and Associated Risk Factors in Intensive Care Unit at the University Of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

Abstract

Background: The burden of blood stream infection and antibiotic resistance in intensive care unit (ICU) is higher when compared with other settings. The data on the infection rate and changing antibiotic resistance trends are important for infection control activities. The aim of this study was to assess the magnitude and risk factors of bacterial pathogens and their antibiotic resistance patterns of blood culture isolates from ICU patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.

Materials and Methods: A cross-sectional study was conducted from February to May 2018. Blood specimen was collected aseptically from 384 patients and inoculated on appropriate culture media. Identification of bacterial pathogens and antibiotic susceptibility tests were performed using bacteriological standard methods. Presence of Extended Spectrum Beta Lactamase (ESBL) enzymes was confirmed by combined disk diffusion method. Cefoxitin was tested as a surrogate marker for oxacillin  (methicillin) to detect methicillin resistant Staphylococcus aureus (MRSA). All materials, equipment, antibiotic disks and procedures were adequately controlled. Data were analyzed using SPSS version 20 by applying binary logistic regression model with multivariable analysis. P-value <0.05 at 95% CI was considered as statistically significant.

Results: Of the 384 study participants, 53.9% were neonates and the most common reasons (40.9%) for hospital admission was early onset neonatal sepsis. From the total samples, 25% were culture positive. K.pneumoniae was the predominant isolate both in neonatal and pediatric ICU and E.coli in adult ICU. Majority of Gram positive and Gram negative isolates were highly sensitive to Clindamycin (83%) and meropenem (84.8%) & ciprofloxacin(83.5%) respectively. The prevalence of MRSA and ESBL enzyme producers was 57.1% and 78.8%, respectively. Age and sex were significantly associated factors with blood stream infection.

Conclusion: Klebsiella species were the predominant bacterial isolates in ICU settings. Clindamycin for Gram positive, meropenem and ciprofloxacin for Gram negative isolates were highly effective. Antibiotic resistance due to ESBL enzyme production is alarmingly high. The high prevalence of Klebseilla species in the ICU may signal inappropriate use of antibiotics and poor infection prevention control practice in these settings. Being male and neonate were more likely to develop bacterial bloodstream infection.