Correlation Between Gram Negative Bacterial Colonization, Environmental Contamination and the Development of Infections at Intensive Care Unit

Eriny Gamil Gayed Gergawy; Laila Ahmed El Attar; Amira Amine; Nashwa Fawzy Abd El Moez Azzam

Author(s)

Eriny Gamil Gayed Gergawy Faculty of Science, University of Alexandri,,Egypt

Laila Ahmed El Attar Microbiology Department, High Institute of Public Health, Alexandria University,,Egypt

Amira Amine Microbiology Department, High Institute of Public Health, Alexandria University,,Egypt

Nashwa Fawzy Abd El Moez Azzam Microbiology Department, High Institute of Public Health, Alexandria University,,Egypt

Abstract

Detection of the source of infection by multidrug resistant gram-negative bacteria (MDR-GNB) may help in the development of effective treatment protocols resulting in improved patient outcomes. The aim of this study was to determine the prevalence of MDR-GNB colonization and infection among patients in ICU and the association between colonization, environmental contamination and infections. Throat swabs were taken from 165 ICU patients within 48 h of admission. Then clinical samples were collected from those patients who developed infections according to the site of infection. Also, weekly environmental samples were obtained from the occupied partition in ICU. Throat colonization by GNB was detected in only 6.06%. About 27 (16%) out of the admitted patients got infections and only 9 patients (5.45%) had hospital acquired infections (HAIs). The rate of environmental contamination due to GNB during the studied period (8 weeks) which was 27.06%. MDR-GNB isolates represented 50% of gram-negative isolates recovered from colonized patients and 86.11% from infected patients and 58.08% from environmental samples. Klebsiella pneumoniae (K. pneumoniae) was the predominant isolate recovered from both colonized and infected patients (50.00% and 38.89% respectively) as well as from environmental samples (48.29%). Extended spectrum beta lactamases (ESBL) and carbapenem resistance were predominant among K. pneumoniae isolates from clinical and environmental samples. High rate of cross contamination between infected patients and their occupied environment was detected among K. pneumoniae and Acinetobacter baumannii complex (Acb complex) isolates.

Publication Details

Page(s) 232-239

DOI DOI not available

Published Journal: Pakistan Journal of Scientific and Industrial Research Series B: Biological Sciences, Volume: 67, Issue: 3, Year: 2024

Request the full text from PASTIC

Keywords

Intensive Care Units, Gram Negative Bacteria, colonization, environmental contamination

References

Ahmed E.H.,Hassan H.-A.M.,El-Sherbiny N.M.,Soliman A.M.A. .2019 .Bacteriological monitoring of inanimate surfaces and equipment in some referral hospitals in Assiut city. International Journal of Microbiology, : 1-9.

CDC ,GA .2019 .Centers for Disease and Control Prevention, US Department of Health and Human Service, Atlanta. , : .

Chaoui L.,Mhand R.,Mellouki F.,Rhallabi N. .2019 .Contamination of the surfaces of a health care environment by multidrug-resistant (MDR) bacteria. International Journal of Microbiology, : 1-7.

CLSI. .2020 .Performance Standards for Antimicrobial Susceptibility Testing. CLSI Supplement M100, : .

Dancer S.J. .2014 .Controlling hospital acquired infection: focus on the role of the environment and new technologies for decontamination. Clinical Microbiology Reviews, 27 : 665-690.

Fouda R.,Soliman M.S.,Abadeer M.G.,Soliman M.,G. M. .2016 .Prevalence and risk factors of MRSA, ESBL and MDR bacterial colonization upon admission to an Egyptian medical ICU. Journal of Infection in Developing Countries, 10 : 329-336.

Galal L.,Abdel Aziz N.A.,Hassan W.M. .2019 .Defining the relationship between phenotypic and genotypic resistance profiles of multidrug-resistant enterobacterial clinical isolates. Advances in Experimental Medicine and Biology, 1214 : 9-21.

Gupta V.,Ye G.,Olesky M.,Lawrence K.,Murray J.,Yu K. .2019 .National prevalence estimates for resistant enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States. International Journal of Infectious Diseases, 85 : 203-211.

Hamam S.S.,Sakr A.A.,Zahran W.A.,El Kholy,Kasemy R.M.,Ibrahem Z.A.,Sakr R.A.,Younis M.A.,F.E. M.A. .2021 .Health care-associated infections at an Egyptian tertiary care hospital: a 2-year prospective study. Menoufia Medical Journal, 34 : 514-520.

Hassan R.,El-Gilany A.-H.,El-Mashad N. .2019 .Device-associated infection rates in different intensive care units in a tertiary care hospital in Egypt. American Journal of Preventive Medicine, 4 : 1-7.

Hopman J.,Tostmann A.,Wertheim H.,Bos M.,Kolwijck E.,Akkermans R.,Sturm P.,Voss A.,Pickkers P.,Vd Hoeven,H. Hoeven .2017 .Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of 'waterfree' patient care. Antimicrobial Resistance Infection Control, 6 : 59.

Ibrahim M.E. .2018 .High antimicrobial resistant rates among gram-negative pathogens in intensive care units. A retrospective study at a tertiary care hospital in southwest Saudi Arabia. Saudi Medical Journal, 39 : 1035-1043.

Khalifa H.O.,Soliman A.M.,Ahmed A.M.,Shimamoto T.,Nariya H.,Matsumoto T.,Shimamoto T. .2019 .High prevalence of antimicrobial resistance in gramnegative bacteria isolated from clinical settings in Egypt: recalling for judicious use of conventional antimicrobials in developing nations. Microbial Drug Resistance, 25 : 371-385.

Khan H.A.,Baig F.K.,Mehboob R. .2017 .Nosocomial infections: epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7 : 478-482.

Gordon A.K.,Mathers A.J.,Cheong E.Y.L.,Gottlieb T.,Kotay S.,Walker A.S.,Peto T.E.A.,Crook D.W.,Stoesser N. .2017 .The hospital water environment as a reservoir for carbapenem-resistant organisms causing hospital-acquired infections-A systematic review of the literature. Clinical Infectious Diseases, 64 : 1435-1444.

Kotb S.,Lyman M.,Ismail G.,Girgis M.,Etman S.A.,Hafez A.,El-Kholy S.,Zaki J.,Rashed M.E.S.,Khalil H.G.,Sayyouh G.M.,Talaat O.,M. O. .2011 .Epidemiology of carbapenemresistant enterobacteriaceae in Egyptian intensive care units using National healthcare-associated infections surveillance data,. , 9 : 2.

Manel D.,Abdelbasset M.,Houria C. .2014 .Prevalence and characterization of extended-spectrum blactamase-producing enterobacteriaceae isolated from hospital environments. Asian Journal of Microbiology, Biotechnology & Environmental Sciences, 16 : 19-27.

Mehraban F.,Rostami M.N.,Douraghi M.,Dolati M. .2016 .Prevalence of environmental gramnegative Bacilli in the intensive care units of hospitals from the city of Qom. Infection, Epidemiology. , 2 : 5-7.

Moolchandani K.,Sastry A.S.,Deepashree R.,Sistla S.,Harish B.N.,Mandal J. .2017 .Antimicrobial resistance surveillance among intensive care units of a tertiary care hospital in southern India. Journal of Clinical and Diagnostic Research, 11 : dc01-dc07.

Podschun R.,Pietsch S.,Höller C.,Ullmann U. .2001 .Incidence of Klebsiella species in surface waters and their expression of virulence factors. Applied and Environmental Microbiology, 67 : 3325-3327.

Ridgway J.P.,Peterson L.R.,Thomson R.B.,Jr. R.B.,Miller B.A.,Wright M.O.,Schora D.M.,Robicsek A. .2014 .Sensitivity of surveillance testing for multidrug-resistant gram-negative bacteria in the intensive care unit. Journal of Clinical Microbiology, 52 : 4047-4048.

Russotto V.,Cortegiani A.,Raineri S.M.,Giarratano A. .2015 .Bacterial contamination of inanimate surfaces and equipment in the intensive care unit. Journal of Intensive Care, 3 : 54.

Sertaridou E.,Papaioannou V.,Kolios G.,Pneumatikos I. .2015 .Gut failure in critical care: old school versus new school. Annals of Gastroenterology, 28 : 309-322.

Shimose L.A.,Masuda E.,Sfeir M.,Caban A.B.,Bueno M.X.,Spychala D.,Cleary C.N.,Namias T.,Kett N.,Doi D.H.,Munoz-Price Y.,L.S. Y. .2016 .Carbapenem-resistant Acinetobacter baumannii: concomitant contamination of air and environmental surfaces. Infection Control and Hospital Epidemiology, 37 : 777-781.

Talaat M.,El-Shokry M.,El-Kholy J.,Ismail G.,Kotb S.,Hafez S.,Attia E.,Lessa F.C. .2016 .National surveillance of health care-associated infections in Egypt: developing a sustainable program in a resource limited country. American Journal of Infection Control, 44 : 1296-1301.

Tille P. .2013 .Bailey & Scott's Diagnostic Microbiology, 13th edition. Elsevier., : .

Vickery K.,Deva A.,Jacombs A.,Allan J.,Valente P.,Gosbell I.B. .2012 .Presence of biofilm containing viable multi-resistant organisms despite terminal cleaning on clinical surfaces in an intensive care unit. The Journal of Hospital Infection, 80 : 52-55.

Wang M.,Wei H.,Zhao Y.,Shang L.,Di L.,Lyu C.,Liu J. .2019 .Analysis of multidrug-resistant bacteria in 3223 patients with hospital-acquired infections (HAI) from a tertiary general hospital in China. Bosnian Journal of Basic Medical Sciences, 19 : 86-93.

Wang S.,Li D.,Chu Y.Z.,Zhu L.Y.,Liu F.Z. .2009 .Determination of oropharyngeal pathogenic colonization in the elderly community. Chinese Medical Journal, 122 : 315-318.

Wang Y.,Ren J.,Yao Z.,Wang W.,Wang S.,Duan J.,Li Z.,Wang R.,X. R. .2023 .Clinical impact and risk factors of intensive care unit-acquired nosocomial infection: a propensity score-matching study from 2018 to 2020 in a teaching hospital in China. Infection and Drug Resistance, 16 : 569-579.

Wißmann J.E.,Kirchhoff L.,Brüggemann Y.,Todt D.,Steinmann J.,Steinmann E. .2021 .Persistence of pathogens on inanimate surfaces: a narrative review. Microorganisms, 9 : 343.