Clinical Response and Outcome in Patients with Multidrug Resistant Gram-negative Infections.
OBJECTIVE
In this study, frequency and antimicrobial sensitivity pattern of multidrug resistant (MDR) microorganisms were evaluated in a referral teaching hospital in Iran.


METHODS
Patients with MDR Gram-negative pathogens were followed during the course of hospitalization. Demographic data, baseline diseases, type of biological sample, isolated microorganism, type of infection, antibiotic regimen before the availability of the culture result and change in the antibiotic regimen following receiving the antibiogram results, response to the treatment regimen, and duration of hospitalization and patient's outcome were considered variables for each recruited patient.


RESULTS
In 71% of the patients, antibiotic regimens were changed according to the antibiogram results. A carbapenem alone or plus amikacin or ciprofloxacin were selected regimens for patients with extended-spectrum beta-lactamase (ESBL) infections. For patients with probable carbapenem-resistantEnterobacteriaceaeinfections, a carbapenem plus colistin was the most common antibiotic regimen. Clinical response was detected in 54.5% of the patients who were treated based on the antibiogram results. Clinical response was higher in the ESBL producers (ESBL-P) than the non-ESBL-P infections (75% vs. 52%). However, this difference was not significant (P= 0.09). Most nonresponders (80%) had sepsis due toKlebsiellaspecies. Finally, 41.9% of the patients were discharged from the hospital and 58.2% died.


CONCLUSIONS
Same as other countries, infections due MDR microorganisms is increasing in the recent years. This type of resistance caused poor clinical response and high rate mortality in the patients.
Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Masoume
M
Malekolkottab
Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Lida
L
Shojaei
Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Hossein
H
Khalili
Central Laboratory, Imam Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Mahsa
M
Doomanlou
Ethiopia; expectation; pharmaceutical services; satisfaction; service quality