Surveillance for Antimicrobial Resistance in the Intensive Care Units of Alexandria University Hospitals

Background: . The problem of  antimicrobial resistant pathogens is under investigated in Egypt and information on their  prevalence in healthcare facilities is lacking, despite the speculated magnitude of the problem as evidenced by infection associated morbidity and mortality rates, encompassed with an unguided antibiotic use.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 e: Objective: Estimate the prevalence of antimicrobial resistant pathogens in the intensive care units of Alexandria University Hospitals.

Methods: Each sample submitted for culture and sensitivity testing from ICUs of Alexandria University Hospitals was processed according to standard microbiological procedures. Antimicrobial sensitivity testing was carried out according to the performance standards set by the Clinical Laboratory Standards Institute (CLSI). All generated results were entered in the Laboratory Data information system (LDIS) WHONET5.4 developed by the WHO for the management of routine laboratory results. Results: Data on a total of 3032 isolate during the period from July 2006 through September 2009 were analyzed. 56% were isolates from patients with CAUTI, 28% from BSI and 16% from VAP. The predominant pathogen was candida spp representing 29% of the total isolates and 52% of urinary isolates. Klebsiella pneumonia, Pseudomonas aeruginosa, Acinetobacter baumanii, Enterococcus faecalis, Escherichia coli, Staphylococcus aureus, and coagulase negative staphylococci were the most prevalent bacterial pathogens (17%, 10%, 9%, 9%, 8%, 8% and 8% respectively) with Klebsiella pneumonia the predominant pathogen associated with BSI and Acinetobacter the predominant isolate associated with VAP.  ESBL production was confirmed in 55% of the Klebseilla pneumonia isolates and 71% of the E coli isolates. 5% of Klebsiella pneumonia isolates were carbapenem resistant. The highest susceptibility Pseudomonas aeruginosa, was shown to amikacin, piperacillin, and cefepime with 62%, 45%, and 44% of isolates being susceptible. 55% of Acinetobacter isolates were panresistant, with only 44 %, 26% and 21% of isolates susceptible to carbapenems, levofloxacin, and tobramycin respectively. Methicillin resistance MRS was encountered in 73% of staphylococcal isolated yet all isolates were sensitive to vancomycin. On the other hand 17% of enterococci were vancomycin resistant (VRE)
Conclusions: An alarming prevalence of AMRPs is encountered at the ICUs of AUHs. The situation demands enhance attempts to review the current trends of antimicrobial utilization as well as infection prevention and control disciplines. The generated information provides a solid base for development of antibiotic policy and demands the development of antibiotic stewardship.  Sharing of the generated information on a national as well as on a global level is a growing mandate in the face of an inevitable pandemic of antimicrobial resistant pathogens.