BACTERIAL PATHOGENS OF NOSOCOMIAL INFECTIONS IN ICUS AND THEIR ANTIBIOTICS RESISTANT PATTERN AT KING KHALID HOSPITAL IN AL-KHARJ/SAUDI ARABIA

Background:The intensive care unit [ICU] is considered as infection epicenter because vulnerable population of critically ill patients and use of different invasive devices. Consequently, the ICU population has one of the highest occurrence rates of nosocomial infections leading to an enormous impact on morbidity, hospital costs, and often survival. In addition, the increasing problem of antibiotic resistance loads the burden of nosocomial infection in the ICU. Constant and careful global monitoring for multidrug-resistant bacteria is needed to minimise the possibility of appearance and dissemination of new resistant isolates and to avoid complications in treatment choices. Methods:This study was carried out from March to June 2016 in King Khalid Hospital [Al-Kharj-KSA] to explore the multidrug-resistant bacteria, Extended Spectrum ????- lactamase bacteria [ESBLs] and the possibility of carbapenems resistant bacteria isolated from clinical samples of patients in the ICUs. A total of 317 different clinical samples were received for cultivation and antibiogram during the study period. Samples were cultivated on Blood agar, MacConkey agar, CLED, EMB agar and Mannitol salt agar. Gram stain, colony morphology and biochemical tests were done.The final identification results of the causative agents and its sensitivity profile were obtained by automated procedures "Phoenix 100/BD company". Minimum inhibitory concentration [MIC] results were interpreted according to Clinical and laboratory standard institute [CLSI] guidelines. Results:Out of 317 total samples processed during the study, significant growth was shown in 62 samples [19.5%]. Respiratory samples showed the highest rate of positive growth [40.3% out of 62] followed by urine [20.96% out of 62]. Fifty-seven isolates [91.94 %] were gram-negative and five isolates [8.06%] were gram-positive. K. pneumoniae was the most frequently isolated among Gram-negative with16 isolates [28%] followed by P. aeruginosa 12 [21%]. All isolates of P. aeruginosa, Acinetobacter spp., Providencia spp., Enterobacter spp., Citrobacter spp., Serratia spp. were MDR [100%] while five isolates [71.4%] of Proteus mirabilis, and 11 [69%] of K. pneumoniae were MDR. ESBLs were confirmed in 39 [83%] isolates out of 47 MDR gram-negatives; among them, 11[28.2%] were K. pneumoniae and10 [25.64%] isolates of P. aeruginosa. Resistance to carbapenems was detected in 23 [48.94%] isolates of MDR gram-negative bacteria; among them, 10 [43.48%] isolates of P. aeruginosa, and 6[26.1%] isolates each of Acinetobacter spp. and K. pneumoniae. Conclusion:Considerable efforts and regular evaluation of ESBL and carbapenems resistant bacteria are of great importance both in hospital and community to avoid the appearance of new bacterial isolates which may resist all clinically used antibiotics. Keywords: Nosocomial infection, MDR, ESBL, Carbapenems, Resistance, Bacteria.