ABSTRACT
Intro: Acinetobacter calcoaceticus - A.baumannii complex is an opportunistic pathogen that has emerged as one of the multidrug resistant organism frequently associated with nosocomial infections especially causing ventilator- associated pneumonia (VAP). Colistin and Polymyxin B are currently being used as salvage therapy for treating MDR Acinetobacter spp. However, the emergence of resistance of colistin has been reported and treatment is further complicated by poor lung tissue penetration. Thus, we implied to explore on the prevalence of its resistance in our own facility, being the national COVID-19 referral hospital. Method(s): This is a cross-sectional retrospective analysis of MDR Acinetobacter spp. done for isolates of 2019 and 2021. Only clinically significant isolates were sent to Institute of Medical Research (IMR) for colistin susceptibility testing by broth microdilution. The identification of the isolates was performed by Bruker MALDI-ToF. CLSI breakpoints were used to determine susceptibility, applying the change of breakpoints interpretation in year 2020. Finding(s): In 2021, out of 203 isolates, 195 (96%) were Acinetobacter baumannii. Other spp. isolated were A. nosocomialis (6, 3%) and A. proteolyticus (2, 1%). Out of that, 107 (52.7%) were resistant with MIC of >4 ug/ml and 96 (47.3 %) were intermediate with MIC of <2 ug/ml. Pre-pandemic, resistance rates were compared with 2019 and this showed 47% were resistant with MIC of >4 ug/ml and 52% were susceptible with MIC <2 ug/ml. Clinical characteristics of patients were analysed;previous use of carbapenem, ventilation history, length of stay, and outcome (alive or deceased). Most of patients were severely ill with majority of admissions due to Category 4-5 COVID-19 and required ventilation in critical care unit. Previous carbapenem exposure was not significantly associated with colistin resistance (p=0.936). Conclusion(s): Emergence of colistin resistant MDR Acinetobacter spp. is alarming. Infection control measures are crucial and other therapeutic options need to be explored to improve quality of care.Copyright © 2023
ABSTRACT
Recent reports have shown that antibiotics were commonly prescribed in COVID-19 designated hospitals throughout the pandemic in spite of it being ineffective in treating viruses such as SARS-COV 2 which is the pathogen responsible for causing COVID-19. We conducted a cross-sectional Point Prevalence Survey (PPS) involving all wards in Hospital Sungai Buloh. Each ward was audited within one day within the period of two weeks (1st December 2021 till 14th December 2021). All in-patients receiving IV or oral antibiotics at 8am on the day of survey were included in the study. A total of 200 out of 664 in-patients (30%) were treated with antibiotics during the study period. COVID ICU recorded the highest prevalence of patient on antibiotics (83%) followed by General Medical (43%). Majority of patients received antibiotics for empirical therapy (80%, 160/200) and community-acquired pneumonia was the most common indication documented (36.5%, 75/205), followed by hospital-acquired pneumonia, with 23.4% of total documented indication (48/205). We found that in half of the patients (104/200), clinicians did not document the indication of antibiotic. Rate of prescription that was compliant to guideline was higher than that of non-compliant to guideline from total of 139 cases recorded (68% vs 32%). We found that there was a significant association between rate of compliant to guideline with respiratory diseases (χ² = 5.37, p<0.05). Twenty-seven percent of patients received antibiotics for respiratory diseases not according to guideline recommendation. Majority of cases of non-compliance to guideline, were patient with respiratory diseases (58.7%, 27 out of 46 cases). This pandemic has had an impact on the use of antibiotics, where its use has been found to increase drastically, especially in critical and severe patients. This high use makes adherence to the guidelines become important and should be an ongoing indicator, also it can be used as a guide for antimicrobial stewardship intervention. [ FROM AUTHOR] Copyright of International Journal of Infectious Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)