title: Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt.
abstract: BACKGROUND
  The prevalence of extensively drug resistant gram negative bacilli (XDR-GNB) is rapidly progressing; however in Egypt data are sparse. We conducted the present study to quantify the incidence, risk factors and outcome of patients harboring XDR-GNB.
  
  
  METHODS
  A one year prospective study was done by collecting all the bacteriological reports for cultures sent from the surgical intensive care unit, Cairo university teaching hospital. XDR-GNB were defined as any gram negative bacilli resistant to three or more classes of antimicrobial agents. Patients with XDR-GNB compared with those sustaining non extensively drug-resistant infection. A multivariate logistic regression model was created to identify independent predictors of multi-resistance.
  
  
  RESULTS
  During one-year study period, a total of 152 samples (65%) out of 234 gram negative bacilli samples developed extensively drug resistant infection. XDR strains were significantly higher in Acinetobacterspp (86%), followed by Pseudomonas (63%), then Proteus (61%), Klebsiella (52%), and E coli (47%). Fourth generation cephalosporine (Cefipime) had the lowest susceptibility (10%) followed by third generation cephalosporines (11%), Quinolones (31%), Amikacin (42%), Tazobactam (52%), Carbapinems (52%), and colistin (90%). Relaparotomy was the only significant risk factor for acquisition of XDR infection.
  
  
  CONCLUSIONS
  Extensively drug-resistant gram negative infections are frequent in our ICU. This is an alarming health care issue in Egypt which emphasizes the need to rigorously implement infection control practices.
authors: Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Ahmed
authors: A
authors: Hasanin
authors: Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Akram
authors: A
authors: Eladawy
authors: Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Hossam
authors: H
authors: Mohamed
authors: Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Yasmin
authors: Y
authors: Salah
authors: Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Ahmed
authors: A
authors: Lotfy
authors: Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Hanan
authors: H
authors: Mostafa
authors: Department of clinical pathology, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Doaa
authors: D
authors: Ghaith
authors: Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors: Ahmed
authors: A
authors: Mukhtar
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D004534:Egypt / Q000453:epidemiology; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D016015:Logistic Models; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents
keywords: Extensive drug resistance; critically ill patients; gram negative bacilli