Objective: The most common resistant gram negative bacteria isolated in hospital-acquired blood stream infections are Pseudomonas aeruginosa, Acinetobacter species and Klebsiella pneumoniae. These infections are associated with increased mortality rates. In this study, we aimed to identify the risk factors for emerging resistant gram negative bacterial infections.
Methods: Data of 280 patients hospitalized in Medical Intensive Care Unit (ICU) between September 1st, 2013 and September 30th, 2014 were reviewed retrospectively.
Results: Resistant gram negative bacterial infections were detected in 80 patients. Acinetobacter baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa were the most resistant strains, respectively. APACHE II score, duration of mechanical ventilation, length of ICU stay and length of hospital stay were independent risk factors for resistant gram negative bacteria isolation. Mechanical ventilation and central venous catheterization were related with increased mortality rates. Length of ICU stay was an independent risk factor for resistant A.baumannii isolation. Prolonged mechanical ventilation, hospital and ICU stay were common risk factors for resistant K.pneumoniae and P.aeruginosa isolation. Total parenteral nutrition was an additional risk factor for resistant K.pneumoniae isolation and mortality rates for K.pneumoniae were higher than the other bacteriae.
Conclusion: In the management of critical patients; prolonged ICU and hospital stays should be avoided as much as possible and central venous catheterization should only be used for appropriate indications and removed as soon as possible to prevent resistant gram negative bacterial infections. In addition, mechanically ventilated patients should be weaned from the ventilator as soon as possible, parenteral nutrition products should not be used instead of enteral nutrition if it’s not necessary and antibiotics must be used appropriately.