Extensive Drug Resistance in Intensive Care Units, Yemen, 2021: A Cross-Sectional Study

The emergence of nosocomial infections (NCI) in Intensive care units (ICUs) that caused by antimicrobial Drug Resistance (AMR) Gram-Negative bacilli (GNB) has become a major public health threat since there is a limited effective treatment. This study is aimed to determine the Prevalence Rate of NCI, and the antibiotic susceptibility pattern of isolates. A cross-sectional study was conducted in six adult ICUs at Al Thawra General hospital, Sana’a, Yemen. A total of 117 admitted patients were included in the study from the period of 1st August to 31st October 2021. A pre-designed questionnaire was used for the collection of socio-demographic and clinical data, various clinical specimens were collected from NCI patients and processed using Vitek 2 automated system to identify the isolates and its susceptibility pattern. Carbapenemase producing was tested by Imipenem-EDTA synergy disc diffusion test according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using Epi-info version 7.2 statistical software packages (CDC, USA), and the results were presented as descriptive statistics: rates & frequency for categorical variables while, mean ±SD or (minimum –maximum) for quantitative variables. The prevalence of NCI in ICUs was 46%. The most isolates were GNB (88%, 52/59). K pneumoniae was the most prevalent (37%, 19/52) while, P aeruginosa and A baumannii were the most resistant. The resistance for tested antibiotics was 98% (51/52) of isolates; 75% of them showed Extensive Drug Resistance (XDR), and 47% were Carbapenemase producers. However, most AMR-GNB is still susceptible to Polymyxin B and Colistin, the resistance has found to be 10% and 12 % respectively. The high prevalence of AMR-NCI in ICUs calls for an urgent establishment of a stewardship program with strict measures of Infection Prevention Control and regular monitoring of the resistant strains.