Incidence of Infections by Multi-Drug Resistant Bacterial and Impact to Determinate the Empirical Antimicrobial Regime

Background: Antimicrobial resistance has been increasing as a serious problem in current medical practice. Infections caused by multi-drug resistant organisms leads to morbidity and mortality increase and expansion in costs with hospitalization. New antimicrobial resistance mechanisms contribute to complicate this situation and the treatment option become limited. In this context, the Skape Group can be highlighted: Meticilin Resistent Staphylococcus aureus (MRSA), Klebisiella pneumoniae carbapenemase producing (KPC), multi-drug resistent Acinetobacter spp and Pseudomonas aeroginosas and vancomicin resistent Enterococcus spp. It’s essential to know the incidence of such bacteria for correct antimicrobial therapy in serious infections.

Objective: Determinate the incidence of  infections caused by Skape Group in the 30 bed clinical (ICUA), 30 bed surgical (ICUB) and 40 bed coronary (ICUC) intensive care units at a cardiology hospital in order to review the empirical antimicrobial therapy recommendations. 

Methods: From November 2009 to October 2010 were included all health care associated infection infections at the three ICU and those caused by SKAPE Group. We evaluated the need to modify the recommendation of the empirical antimicrobial therapy for treatment of serious infections.

Results: At ICUA the incidence of infections was 22.3 per 1000 patient-day (n=217) and the etiological agents were: 5.26 for MRSA, 0.84 for KPC, 2.25 for Acinetobacter spp and 1.60 for Pseudomonas aeruginosas e 0.56 for vancomicin resistent Enterococcus spp. At ICUB the incidence of infections was 12.9 per 1000 patient-day (n=150) and the etiological agents were: 2.2 for MRSA, 1.18 for KPC, 1.33 for Acinetobacter spp and 0.63 for Pseudomonas aeruginosas e 0.63 for vancomicin resistent Enterococcus spp. At ICUC the incidence of infections was 10.2 per 1000 patient-day (n=101) and the etiological agents were: 0.65 for MRSA, 0.00 for KPC, 0.28 for Acinetobacter spp, 0.09 for Pseudomonas aeruginosas e 0.28 for vancomicin resistent Enterococcus spp.

Conclusions: Incidence of vancomicin resistent Enterococcus spp was low in all units and it was not necessary the use of drugs to treat this agent in empirical antimicrobial regime. In ICUC, the incidence of SKAPE Group infection was low and MRSA was the most important agent. We should use empirical antimicrobial regime for SKAPE Group bacteria in ICUA and ICUB for serious infections except anti enterococcal drugs.