Burden and risk factors of acquisition of multidrug-resistant Gram-negative bacteria among intensive care patients at a tertiary care setting

Introduction Multidrug-resistant gram-negative bacteria (MDR-GNB) is a major healthcare challenge, particularly among patients admitted to intensive care units (ICU). The objective of the current study was to assess the risk of acquisition of MDR-GNB in ICU patients and its associated risk factors and outcomes. Methods A prospective cohort study among adult ICU patients was conducted in two tertiary care hospitals in Riyadh, Saudi Arabia, between 2021 and 2022. Specimens were examined at admission, during stay, and before discharge for all patients. Acquisition of MDR-GNB was confirmed by a positive culture/PCR before discharge among patients who were negative at admission. Results A total of 307 patients were included. The mean age was 56.7±18.2 years and 62.2% were males. Out of 307, 82 (26.7%) patients acquired MDR-GNB during their ICU stay. The most common MDR-GNB pathogens were Klebsiella spp. (47.1%), Acinetobacter spp. (14.7%), Pseudomonas aeruginosa (12.7%), Enterobacter spp. (10.8%), and Escherichia coli (5.9%). Approximately 40.2% of MDR-GNB were presented as infection and 59.8% as colonization. In multivariate analysis, the following variables were independent predictors of MDR-GNB acquisition; pneumonia at admission, central line use, urinary catheter use, renal comorbidity, and prolonged hospitalization. Patients who acquired MDR-GNB had significantly higher mortality (34.1% versus 5.3%, p<0.001) and ICU length of stay (median of 26 versus 10 days, p<0.001). Conclusions The findings underscore the high risk and burden of MDR-GNB acquisition in ICU setting. There is urgent need for enhanced infection control strategies and antimicrobial stewardship activities to reduce the acquisition and its negative impact.