The microbiological epidemiology of a rural intensive care unit in Ecuador
Abstract
Objective: There is much information on the causes of bacterial infections in Intensive Care Units (ICU) in high-income countries. On the other hand, there is a lack of the same information from ICUs in low- and middle-income countries (LMIC). Furthermore, there is a paucity of these data from rural ICUs in LMIC.
Methodology: A retrospective and descriptive study of the bacterial profile of a new rural ICU in Ecuador that has a microbiology laboratory for a period of three years is presented.
Results: A total of 336 isolates were collected during 36 months of tracheal aspirate 142 (42.4%), Urine 46 (13.7%), Blood 37 (11.0%), Wound 29 (8.6%), Liquid 21 (6.3%), Others 62 (18.4%). Isolated organisms included: Klebsiella pneumoniae 85 (25.3%) was the most common isolate, followed by E coli 66 (19.6%), Pseudomonas aeruginosa 55 (16.4%), Staphylococcus 52 (15.5%), Candida 14 (4.2%), Enterococcus 9 (2.7%), and Acinetobacter 7 (2.1%). 60% of Staphylococcus aureus isolates demonstrated resistance to Cefoxitin / Oxacillin (MRSA). Among the gram negative bacilli, the multi-resistant bacteria were Pseudomonas sp (21.8%), Klebsiella sp (44.7%), Escherichia sp (19.7%).
Conclusion: The microbiological epidemiology and the presence of resistance and multi-resistance of a new rural ICU in Ecuador is similar to the epidemiology of other units. Klebsiella, E coli, Pseudomonas, and S. aureus predominate. There is new evidence for earlier suspension or de-escalation of antibiotics. Using tools such as CPIS, in certain patients it may be considered to suspend antibiotics after 6 days of therapy. Family physicians managing patients discharged from the ICU should be aware of this new evidence to minimize the unnecessary use of antibiotics.
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