Nosocomial bacterial infections and antimicrobial resistance among the elderly in geriatric unit of Ain Shams university hospital

ABSTRACT

Increasing numbers of elderly people are being treated in hospitals and are additionally at particular risk of acquiring nosocomial infections [Nl] with antibiotic-resistant organisms. Prevalence of Nl had been evaluated in this study in all inpatients in Geriatric Medicine Unit, EL Demerdash Hospital of Ain Shams University from March 2004 till September 2006. The association of Nl with intrinsic and extrinsic risk factors was also assessed, as well as the emergence of antibiotic resistant bacterial strains. All specimens were processed by routine methods and their antibiotic sensitivity was performed using the disc diffusion method in accordance with the Clinical and Laboratory Standards Institute [CLSI] guide lines. A total of 107 NIs were found among 100 of the 1202 hospitalized patients [prevalence 8.2% prevalence varied greatly from 3.3% in the internal ward to 14.2% in the ICU]. Respiratory tract as well as urinary tract infections was the most common NIs [43% each]. The most commonly isolated pathogens from ICU and the internal ward were Klebsiella spp.[25%], Candida spp.[12%], Pseudomonas aeruginosa [12%] and methicillin-resistant Staphylococcus aureus [MRSA] [9%]. They were followed by Escherichia coli and Enterobacter spp. [7.5% each], coagulase negative Staphylococci [6%] and Proteus spp. [5%]. Depending on infection site, the most frequent isolates were Klebsiella spp. [41%], MRSA [22%] for respiratory tract infection; Candida spp. [28%], Klebsiella pneumonie [15%], E.coli and Pseudomonas auruginosa [13% each] for urinary tract infection. Our results showed that 61.9% of studied patients with lower respiratory infections were due to endotracheal intubation and 95.2% of patients had urinary catheters and developed urinary tract infections. About 82.0% of the elderly patients were taking antibiotics, for at least 1 month prior to admission, which have contributed to the emergence of highly resistant pathogens among geriatric patients, including methicillin-resistant Staphylococcus aureus, penicillin-resistant Streptococcus spp., and multiple-drug-resistant Gram-negative bacilli and coagulase-negative staphylococcal strains. Colonization and infection with antibiotic resistant bacteria [ARB] is a rising menace in geriatric medicine. Establishing a surveillance system and developing an antibiotic policy provide the basis for antibiotic therapy and controlling antimicrobial resistance