https://doi.org/10.4081/acbr.2021.162
Pathogens and antimicrobial resistance amongst stroke patients in the intensive care unit: A five years review from Benin City, Nigeria
Submitted: 4 September 2021
Accepted: 25 October 2021
Published: 16 November 2021
Accepted: 25 October 2021
Abstract Views: 379
PDF: 163
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Severe stroke may necessitate intensive care unit admission, but there is a heightened risk of acquiring infection with use of ICU devices. Data regarding infection, pathogens and microbial resistance amongst stroke patients admitted into the ICU is scanty in Nigeria. This study aims to describe the infections, pathogens and antibiotics resistance pattern amongst stroke patients admitted into the ICU. It was a retrospective study. The ICU admission records of all stroke patients at the University of Benin Teaching Hospital from January 2014 to September 2019 were reviewed. The data obtained were the demographics, the types of stroke, results of microbiological studies on endotracheal aspirates, urine specimen, blood specimen, wound swab, vascular catheters, urinary catheters and the antibiogram pattern. One hundred and eight stroke patients were admitted into the ICU during the 5-year under review. The mean age was 61.8 with 51% being females and 52% having ischemic stroke. Seventy-five percent of the stroke patient had hospital acquired infection. Ventilator associated pneumonia accounted for 67.1% of infections, urinary tract infection was 22.8%, and blood stream infection 6.3% while 3.7% had infected decubitus ulcers. Microbial isolates were, Enterobacter sakazakii, accounting for 43.5%, Klebsiella pneumonia 13%, Escherichia coli 11.1%, and Proteus mirabilis 7.4% while 48% had Plasmodium falciparum infection. The micro-bacteria isolates were multi-antibiotics resistant, with the highest resistance for cotrimazole, cefuroxime and ceftazidime. The stroke patient in the ICU is susceptible to developing drug resistant hospital acquired infections, which could increase mortality. Ensuring minimal cases of ICU infection with continuous antimicrobial surveillance and robust antibiotics policy should be the goal.
Kim J, Thayabaranathan T, Donnan GA, et al. Global Stroke Statistics 2019. Int J Stroke. 2020;15:819-38.
DOI: https://doi.org/10.1177/1747493020909545
Gardener H, Sacco RL, Rundek T, et al. Race and ethnic disparities in stroke incidence in the Northern Manhattan study. Stroke 2020;51:1064-9.
DOI: https://doi.org/10.1161/STROKEAHA.119.028806
Alonso A, Ebert AD, Kern R, et al. Outcome predictors of acute stroke patients in need of intensive care treatment. Cerebrovasc Dis 2015;40:10-7.
DOI: https://doi.org/10.1159/000430871
Crawshaw AA, Cock HR. Medical management of status epilepticus: Emergency room to intensive care unit. Seizure 2020;75:145-52.
DOI: https://doi.org/10.1016/j.seizure.2019.10.006
Pinto VL, Tadi P, Adeyinka A. Increased intracranial pressure. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
de Montmollin E, Terzi N, Dupuis C, et al. One-year survival in acute stroke patients requiring mechanical ventilation: a multicenter cohort study. Ann Intensive Care 2020;10:53.
DOI: https://doi.org/10.1186/s13613-020-00669-5
Sulter G, Elting JW, Langedijk M, et al. Admitting acute schemic stroke patients to a stroke care monitoring unit versus a conventional stroke unit: a randomized pilot study. Stroke 2003;34:101–4.
DOI: https://doi.org/10.1161/01.STR.0000048148.09143.6C
Despotovic A, Milosevic B, Milosevic I, et al. Hospital acquired infections in the adult intensive care unit, epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality. Am J Infect Control 2020;48:1211-5.
DOI: https://doi.org/10.1016/j.ajic.2020.01.009
Allegranzi B, Nejad SB, Combescure C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377:228–41.
DOI: https://doi.org/10.1016/S0140-6736(10)61458-4
Rosenthall VD, Maki DG, Salomao R, et al. Device associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 2006;145:582-91.
DOI: https://doi.org/10.7326/0003-4819-145-8-200610170-00007
Arefian H, Hagel S, Fischer D, et al. Estimating extra length of stay due to healthcare-associated infections before and after implementation of a hospital-wide infection control program. PloS One 2019;14:e0217159.
DOI: https://doi.org/10.1371/journal.pone.0217159
World Health Organization. Health care-associated infections fact sheet. WHO; 2020. Available at: http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf
European Centre for Disease Prevention and Control. Annual epidemiological report 2014. Antimicrobial resistance and healthcare-associated infections. Stockholm: ECDC; 2015. Available from: https://www.ecdc.europa.eu/en/publications-data/antimicrobial-resistance-and-healthcare-associated-infections-annual
European Centre for Disease Prevention and Control. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2013. Available from: https://www.ecdc.europa.eu/en/publications-data/point-prevalence-survey-healthcare-associated-infections-and-antimicrobial-use-0
European Centre for Disease Prevention and Control. European Surveillance of Healthcare Associated Infections in Intensive Care Units—HAI-Net ICU Protocol, Version 1.02; ECDC: Stockholm, Sweden, 2015. Available online: https://www.ecdc.europa.eu/en/publications-data/european-surveillance-healthcare-associated-infections-intensive-care-units-hai
Iwuafor AA, Ogunsola FT, Oladele RO, et al. Incidence, clinical outcome and risk factors of intensive care unit infections in the Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. PLoS One 2016;11:e0165242.
DOI: https://doi.org/10.1371/journal.pone.0165242
BO Bolaji, IK Kolawole. The intensive care unit of the University Teaching Hospital, Ilorin, Nigeria: A ten year review (1991–2001). Southern Afr J Anaesth Analges 2005;11:146150.
DOI: https://doi.org/10.1080/22201173.2005.10872416
Yunusa T, Adeoye AM, Akitoye OA. Profile of septic work up among patients admitted into the intensive care unit in University of Abuja teaching hospital Gwagwalada, Abuja. Afr J Clin Experiment Microbiol 2019:20:9-16.
DOI: https://doi.org/10.4314/ajcem.v20i1.2
Iregbu K, Sonibare SA. Profile of infections in Intensive Care Unit (ICU) in a Central Nigeria tertiary hospital. Afr J Clini Exper Microbiol 2015;16:23-7.
DOI: https://doi.org/10.4314/ajcem.v16i1.4
Iliyasu G, Daiyab FM, Tiamiyu AB, et al. Nosocomial infections and resistance pattern of common bacterial isolates in an intensive care unit of a tertiary hospital in Nigeria: A 4-year review. J Critical Care 2016:34:116-20.
DOI: https://doi.org/10.1016/j.jcrc.2016.04.018
Agaba P, Tumukunde J, Tindimwebwa JVB, Kwizera A. Nosocomial bacterial infections and their antimicrobial susceptibility patterns among patients in Ugandan intensive care units: a cross sectional study. BMC Res Notes 2017;10:349.
DOI: https://doi.org/10.1186/s13104-017-2695-5
Claver HP, Ernest A, Philippe A, et al. Epidemiology and prognostic factors of stroke in intensive care unit at the National University Hospital Hubert Koutoukou Maga (CNHU-HKM) of Cotonou. Anesthesia Critical Care 2020;2:1-7.
Fahim NAE. Prevalence and antimicrobial susceptibility profile of multidrug-resistant bacteria among intensive care units patients at Ain Shams University Hospitals in Egypt-a retrospective study. J Egypt Public Health Assoc 2021;96:7.
DOI: https://doi.org/10.1186/s42506-020-00065-8
Bhagwanjee S, Scribante J, Paruk F. Prevalence of ICU infection in South Africa and accuracy of treating physician diagnosis and treatment. Crit Care 2009;13:P347.
DOI: https://doi.org/10.1186/cc7511
Garner JS, Jarvis WR, Emori TG, et al. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128-40.
DOI: https://doi.org/10.1016/0196-6553(88)90053-3
Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 1999;27:887-92.
DOI: https://doi.org/10.1097/00003246-199905000-00020
Long CA, Hoffman SL. Parasitology. Malaria- from infant to genomics to vaccines. Science 2002;297:345-7.
DOI: https://doi.org/10.1126/science.1074484
Vincent JL, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017. JAMA 2020;323:1478-87.
DOI: https://doi.org/10.1001/jama.2020.2717
Manchanda V, Suman U, Singh N. Implementing infection prevention and control programs when resources are limited. Curr Treat Options Infect Dis 2018;10:28–39.
DOI: https://doi.org/10.1007/s40506-018-0142-3
Nazir A, Kadri S. An overview of hospital acquired infections and the role of the microbiology laboratory. Int J Res Med Sci 2017;2:21-27.
DOI: https://doi.org/10.5455/2320-6012.ijrms20140205
Yatin-Mehta Y, Jaggi N, Rosenthal VD, et al. Device-associated infection rates in 20 cities of India, data summary for 2004-2013: findings of the International Nosocomial Infection Control Consortium. Infect Control Hosp Epidemiol 2016;37:172-81.
DOI: https://doi.org/10.1017/ice.2015.276
Uc-Cachón AH, Gracida-Osorno C, Luna-Chi IG, et al. High prevalence of antimicrobial resistance among gram-negative isolated bacilli in intensive care units at a tertiary-care hospital in Yucatán Mexico. Medicina (Kaunas) 2019;55:588.
DOI: https://doi.org/10.3390/medicina55090588
Breeuwer P, Lardeau A, Peterz M, Joosten HM. Desiccation and heat tolerance of Enterobacter sakazakii. J Appl Microbiol 2003;95:967-73.
DOI: https://doi.org/10.1046/j.1365-2672.2003.02067.x
Zilahi G, Artigas A, Martin-Loeches I. What’s new in multidrug-resistant pathogens in the ICU? Ann Intensive Care 2016;6:96.
DOI: https://doi.org/10.1186/s13613-016-0199-4
Segagni Lusignani L, Presterl E, Zatorska B, et al. Infection control and risk factors for acquisition of carbapenemase-producing enterobacteriaceae. A 5 year (2011-2016) case-control study. Antimicrob Resist Infect Control 2020;9:18.
DOI: https://doi.org/10.1186/s13756-019-0668-2
Zhang H, Guo Z, Chai Y, et al Z. Risk factors for and clinical outcomes of carbapenem-resistant Klebsiella pneumoniae nosocomial infections: A retrospective study in a tertiary hospital in Beijing, China. Infect Drug Resist 2021;14:1393-1401.
DOI: https://doi.org/10.2147/IDR.S298530
Abduzaimovic A, Aljicevic M, Rebic V, et al. Antibiotic resistance in urinary isolates of Escherichia coli. Mater Sociomed 2016;28:416–9.
DOI: https://doi.org/10.5455/msm.2016.28.416-419
Ali I, Rafaque Z, Ahmed S, et al. Prevalence of multi-drug resistant uropathogenic Escherichia coli in Potohar region of Pakistan. Asian Pac J Trop Biomed 2016;6:60–6.
DOI: https://doi.org/10.1016/j.apjtb.2015.09.022
Asadi Karam MR, Habibi M, Bouzari S. Urinary tract infection: Pathogenicity, antibiotic resistance and development of effective vaccines against Uropathogenic Escherichia coli. Mol Immunol 2019;108:56–67.
DOI: https://doi.org/10.1016/j.molimm.2019.02.007
Hitzenbichler F, Simon M, Holzmann T, et al. Antibiotic resistance in E. coli isolates from patients with urinary tract infections presenting to the emergency department. Infection 2018;46:325–31.
DOI: https://doi.org/10.1007/s15010-018-1117-5
Idil N, Candan ED, Rad AY, Aksoz N. High trimethoprim-sulfamethoxazole resistance in ciprofloxacin-resistant Escherichia coli strains isolated from urinary tract infection. Minerva Biotecnol 2016;28:159–63.
Prasada S, Bhat A, Bhat S, et al. Changing antibiotic susceptibility pattern in uropathogenic Escherichia coli over a period of 5 years in a tertiary care center. Infect Drug Resist 2019;12:1439–43.
DOI: https://doi.org/10.2147/IDR.S201849
Armbruster CE, Mobley HLT, Pearson MM. Pathogenesis of Proteus mirabilis Infection. EcoSal Plus 2018;8:0009.
DOI: https://doi.org/10.1128/ecosalplus.ESP-0009-2017
Papazian L, Klompas M, Luyt CE. Ventilator-associated pneumonia in adults: a narrative review. Intensive Care Med 2020;46:888-906.
DOI: https://doi.org/10.1007/s00134-020-05980-0
Kharel S, Bist A, Mishra SK. Ventilator-associated pneumonia among ICU patients in WHO Southeast Asian region: A systematic review. PLoS One 2021;16:e0247832.
DOI: https://doi.org/10.1371/journal.pone.0247832
Gahlot R, Nigam C, Kumar V, et al. Catheter-related bloodstream infections. Int J Crit Illn Inj Sci 2014;4:162-7.
DOI: https://doi.org/10.4103/2229-5151.134184
Braga IA, Campos PA, Gontijo-Filho PP, Ribas RM. Multi-hospital point prevalence study of healthcare-associated infections in 28 adult intensive care units in Brazil. J Hosp Infect 2018;99:318-24.
DOI: https://doi.org/10.1016/j.jhin.2018.03.003
Sabino SS, Lima CA, Machado LG, et al. Infections and antimicrobial resistance in an adult intensive care unit in a Brazilian hospital and the influence of drug resistance on the thirty-day mortality among patients with bloodstream infections. Rev Soc Bras Med Trop 2020:22:e20190106.
DOI: https://doi.org/10.1590/0037-8682-0106-2019
Tian L, Zhang Z, Sun Z. Antimicrobial resistance trends in bloodstream infections at a large teaching hospital in China: a 20-year surveillance study (1998-2017). Antimicrob Resist Infect Control 2019:28:86.
DOI: https://doi.org/10.1186/s13756-019-0545-z
How to Cite
Odiase, F., & Lofor, P. (2021). Pathogens and antimicrobial resistance amongst stroke patients in the intensive care unit: A five years review from Benin City, Nigeria. Annals of Clinical and Biomedical Research, 2(2). https://doi.org/10.4081/acbr.2021.162
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.