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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References
2. Rosenthal VD, Bijie H, Maki DG, et al, Members I (2012) International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004–2009. Am J Infect Control 40:396–407
3. Dunser MW, Bataar O, Tsenddorj G, et al. Differences in critical care practice between an industrialized and a developing country. (2008) Wien Klin Wochenschr 120:600–607
4. Kissoon N, Daniels R, van der Poll T, Finfer S, Reinhart K (2016) Sepsis-the final common pathway to death from multiple organ failure in infection. Crit Care Med 44:e446
5. Sharma S, Hadda V, Mathur P, et al. Profile of micro-organisms in intensive care unit of a level-1 trauma centre: a retrospective study. Indian J Crit Care Med. 2013 Mar-Apr; 17(2):87-91
6. A.-P. Magiorakos, A. Srinivasan, R. B. Carey et al., “Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance,” Clinical Microbiology and Infection, vol. 18, no. 3, pp. 268–281, 2012.
7. Vernet G, Mary C, Altmann DM, et al. (2014) Surveillance for antimicrobial drug resistance in underresourced countries. Emerg Infect Dis 20:434–441
8. Kumar A: Early antimicrobial therapy in severe sepsis and septic shock. Curr Infect Dis Rep. 2010, 12: 336-344.
9. Hranjec T, Rosenberger LH, Swenson B, et al: Aggressive versus conservative initiation of antimicrobial treatment in critically ill surgical patients with suspected intensive-care-unit-acquired infection: a quasi-experimental, before and after observational cohort study. Lancet Infect Dis. 2012, 12: 774-780.
10. Dellinger RP, Levy MM, Rhodes A, et al: Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med. 2013, 41: 580-637.
11. Singh N, Rogers P, Atwood CW, Wagener MM, Yu VL: Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit. A proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med. 2000, 162: 505-511.
12. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Mervyn Singer, Clifford S. Deutschman, Christopher Warren Seymour, Manu Shankar-Hari, Djilali Annane, Michael Bauer et at. JAMA 2016;315(8):801-810.doi:10.0001/jama.2016.0287
13. Cornely OA, Bassetti M, Calandra T, et al. Escmid* guideline for the diagnosis and management of candida diseases 2012: non-neutropenic adult patients. Clin Microbiol Infect. 2012, 18: 19-37.
14. Guidelines for the management of adults with hospital-acquired,ventilator-associated, and healthcare-associated pneumonia. Am J Resp and Critical Care. 171 (4) https://doi.org/10.1164/rccm.200405-644ST
15. Luna CM, Blanzaco D, Niederman MS, et al. Resolution of ventilator-associated pneumonia: prospective evaluation of the clinical pulmonary infection score as an early clinical predictor of outcome. Crit Care Med. 2003;31:676–82.
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