Characteristics Of Multidrug Resistance Antibiotic Patients In Patients Treated In Intensive Care Unit Unit Haji Adam Malik Hospital Medan
Introduction
Nosocomial infections are a significant concern for patients treated in the intensive care unit (ICU). These infections are associated with high medical expenses, prolonged hospital stays, and increased morbidity and mortality. Patients treated in the ICU are at a higher risk of dying from infections compared to those who are not treated in the ICU. Moreover, patients with multidrug-resistant (MDR) pathogens have a higher risk of death in the ICU than those with non-MDR pathogens. Therefore, it is crucial to rapidly and accurately identify patients at high risk of colonization by MDR microorganisms to apply screening protocols, precise preventive measures, and provide appropriate treatment, such as avoiding antibiotic abuse.
Background
The increasing prevalence of MDR pathogens is a significant challenge in the management of patients in the ICU. The overuse and misuse of antibiotics have contributed to the development of antibiotic resistance, making it essential to adopt a more rational approach to antibiotic use. The World Health Organization (WHO) has emphasized the need to improve antibiotic stewardship and reduce the incidence of nosocomial infections. This study aims to determine the characteristics of MDR antibiotic patients treated in the ICU at Haji Adam Malik Hospital Medan.
Methodology
This study employed a cross-sectional research design with a retrospective method. Secondary data was collected from the ICU medical records during the period of September 2022 to September 2023. A total of 100 samples were analyzed. The data collected included demographic information, clinical characteristics, and laboratory results.
Results
The results showed that 69% of the samples were men, with an average age of 52.8 years (± 15.2 years). The average length of treatment in hospitals was 14.6 days. A total of 57 samples were in severe condition, with chronic kidney failure being the most common accompanying disease, detected in 24 samples. The antibiotics that showed the most resistance were cefazolin, with a resistance rate of 89%. The most common cultural results found in MDR patients were Acinetobacter Baumannii, recorded in 39 samples.
Discussion
The findings of this study provide valuable insights into the characteristics and challenges faced in the management of MDR patients in the ICU. The dominance of men in the study population, with an average age of 52.8 years, suggests that older men are at a higher risk of developing MDR infections. The high prevalence of chronic kidney failure as an accompanying disease highlights the importance of considering underlying comorbidities in the management of MDR patients.
The high resistance rate of cefazolin is a concern, as this antibiotic is commonly used in the treatment of infections in the ICU. The cultural results showing infection by Acinetobacter Baumannii are also alarming, as this bacterium is known to be resistant to multiple antibiotics. The findings of this study emphasize the need for hospitals to improve the practice of antibiotic use and strengthen infection prevention protocols to reduce the incidence of nosocomial infections, especially in intensive care units.
Conclusion
This study provides an important insight into the characteristics and challenges faced in the management of MDR patients in the ICU. The findings highlight the need for hospitals to adopt a more rational approach to antibiotic use and strengthen infection prevention protocols. By improving antibiotic stewardship and reducing the incidence of nosocomial infections, hospitals can reduce the risk of MDR infections and improve patient outcomes.
Recommendations
Based on the findings of this study, the following recommendations are made:
- Improve antibiotic stewardship: Hospitals should adopt a more rational approach to antibiotic use, including the use of antibiotic susceptibility testing and the implementation of antibiotic stewardship programs.
- Strengthen infection prevention protocols: Hospitals should strengthen infection prevention protocols, including the use of personal protective equipment, hand hygiene, and environmental cleaning.
- Reduce the incidence of nosocomial infections: Hospitals should implement strategies to reduce the incidence of nosocomial infections, including the use of antimicrobial agents and the implementation of infection control measures.
- Monitor and track antibiotic resistance: Hospitals should monitor and track antibiotic resistance patterns to inform antibiotic use and infection prevention strategies.
Limitations
This study has several limitations, including:
- Retrospective design: The study employed a retrospective design, which may be subject to biases and limitations.
- Limited sample size: The study had a limited sample size, which may not be representative of the broader population.
- Data collection: The study relied on secondary data collection, which may be subject to errors and inaccuracies.
Future Directions
Future studies should aim to:
- Investigate the causes of MDR antibiotic resistance: Studies should investigate the causes of MDR antibiotic resistance, including the role of antibiotic use and infection prevention practices.
- Develop and implement effective infection prevention protocols: Studies should develop and implement effective infection prevention protocols, including the use of personal protective equipment, hand hygiene, and environmental cleaning.
- Monitor and track antibiotic resistance: Studies should monitor and track antibiotic resistance patterns to inform antibiotic use and infection prevention strategies.
By addressing these limitations and future directions, hospitals can improve the management of MDR patients in the ICU and reduce the risk of antibiotic resistance.
Q: What is multidrug resistance (MDR) antibiotic resistance?
A: MDR antibiotic resistance refers to the ability of bacteria to resist the effects of multiple antibiotics, making them difficult to treat with conventional antibiotics.
Q: What are the causes of MDR antibiotic resistance?
A: The causes of MDR antibiotic resistance include the overuse and misuse of antibiotics, poor infection control practices, and the spread of antibiotic-resistant bacteria through healthcare settings.
Q: What are the risks associated with MDR antibiotic resistance?
A: The risks associated with MDR antibiotic resistance include increased morbidity and mortality, prolonged hospital stays, and increased healthcare costs.
Q: How can hospitals prevent the spread of MDR antibiotic resistance?
A: Hospitals can prevent the spread of MDR antibiotic resistance by implementing effective infection control practices, such as hand hygiene, personal protective equipment, and environmental cleaning. They can also adopt a more rational approach to antibiotic use, including the use of antibiotic susceptibility testing and antibiotic stewardship programs.
Q: What are the most common MDR bacteria found in hospitals?
A: The most common MDR bacteria found in hospitals include Acinetobacter Baumannii, Pseudomonas aeruginosa, and Escherichia coli.
Q: How can patients prevent the spread of MDR antibiotic resistance?
A: Patients can prevent the spread of MDR antibiotic resistance by following infection control practices, such as hand hygiene, and by asking their healthcare providers about the risks and benefits of antibiotic use.
Q: What are the consequences of not addressing MDR antibiotic resistance?
A: The consequences of not addressing MDR antibiotic resistance include increased morbidity and mortality, prolonged hospital stays, and increased healthcare costs. It can also lead to the development of "superbugs" that are resistant to all available antibiotics.
Q: How can healthcare providers address MDR antibiotic resistance?
A: Healthcare providers can address MDR antibiotic resistance by adopting a more rational approach to antibiotic use, including the use of antibiotic susceptibility testing and antibiotic stewardship programs. They can also implement effective infection control practices, such as hand hygiene, personal protective equipment, and environmental cleaning.
Q: What role can patients play in addressing MDR antibiotic resistance?
A: Patients can play a crucial role in addressing MDR antibiotic resistance by asking their healthcare providers about the risks and benefits of antibiotic use, following infection control practices, and advocating for antibiotic stewardship programs in their healthcare settings.
Q: What are the future directions for addressing MDR antibiotic resistance?
A: The future directions for addressing MDR antibiotic resistance include the development of new antibiotics, the implementation of antibiotic stewardship programs, and the improvement of infection control practices. It also includes the development of new diagnostic tools and the use of advanced technologies, such as artificial intelligence and machine learning, to predict and prevent the spread of MDR antibiotic resistance.
Q: What are the key takeaways from this study?
A: The key takeaways from this study include the importance of addressing MDR antibiotic resistance, the need for hospitals to adopt a more rational approach to antibiotic use, and the importance of implementing effective infection control practices. It also highlights the need for patients to be aware of the risks and benefits of antibiotic use and to advocate for antibiotic stewardship programs in their healthcare settings.