Multiple Drug-Resistant Bacterial Infections among Intensive Care Units – a Nationwide Study

Background: There is an alarming increase in multi-drug resistant (MDR) bacterial infections worldwide. The Mediterranean region, including Jordan, reports a particularly high prevalence of hospital-acquired MDR infections, especially in Intensive Care Units (ICUs).
Aim: To investigate the prevalence, antibiotic susceptibility, risk factors, and resistance genes associated with bacterial infections in ICUs across Jordan.
Methodology: A total of 177 bacterial isolates were collected from 12 ICUs across Jordan between September 2019 and April 2022. Patient demographics, isolate characterization, antibiotic susceptibility, and resistance genes were recorded and analyzed.
Results: The isolates included Klebsiella (22.6%), Staphylococcus (18.0%), Escherichia (17.5%), Acinetobacter (16.4%), Enterococcus (6.2%), Pseudomonas (6.2%), and others (13.0%). Of all isolates, 41.2% were MDR, 17.5% were extensive drug-resistant (XDR), and 6.8% were pandrug-resistant (PDR). MDR rates were highest in Klebsiella (82%), followed by Acinetobacter (79%), Pseudomonas (63%), Staphylococcus (56%), and Escherichia (51%). High resistance rates were observed for all antibiotics except vancomycin, colistin, linezolid, and teicoplanin (˂10%). Significant associations were found between MDR infections and Gram-negative bacteria, central lines, mechanical ventilation, nasogastric tubes, a history of recurrent infections, previous surgeries, bedridden patients, prophylactic antibiotic use, recent antibiotic exposure in the last two weeks, and elevated white blood cell counts (P˂0.05). MDR infections were also significantly linked to higher rates of complications and death (P˂0.05). The most common resistance genes identified were KPC in K. pneumoniae (28.6%), mecA for Staphylococci (62.5%), CTX-M among E. coli (48.4%), OXA-51 and OXA-23 genes in A. baumannii/spp (100%) and vanA gene for E. faecalis/spp (45.5%).
Conclusion: ICUs serve as critical reservoirs for MDR bacterial infections. Implementation of nationwide, evidence-based antibiotic stewardship programs is strongly recommended.