Impact of antimicrobial stewardship in intensive care units by multi-drug-resistant organism surveillance – An approach for a better future

Objectives The objective of this study was to screen patients in the intensive care unit (ICU) for multidrug-resistant organisms (MDROs) and analyze the most common risk factors for infection. The aim was to provide a clinical reference for improving the prognosis of these patients through enhanced antimicrobial stewardship (AMS) measures and infection control practices. Material and Methods This study was conducted over a 2-year period (June 2021-June 2023) in the ICUs, high dependency units (HDUs), and other wards of a tertiary care hospital. All ICU patients were screened for MDRO colonization, and those with risk factors were analyzed. The inclusion criteria included patients aged 18 years or older with complete medical records who received treatment in the ICU, HDUs, and other wards. Results The study identified 105 MDRO cases, with the most common organisms being Klebsiella pneumoniae (30 cases), Acinetobacter baumanii (23 cases), and Pseudomonas aeruginosa (17 cases). Carbapenem resistance was highest in Klebsiella pneumoniai (28 cases), followed by E. coli (26 cases), Acinetobacter baumanii (19 cases), and Pseudomonas aeruginosa (11 cases). Colistin resistance was most frequently observed in Klebsiella pneumoniae (51 cases). The most common wards with MDRO cases were the emergency intensive care unit (EICU), neuroscience intensive care unit (NSICU), and one of the three HDUs, and the most frequent specimens were tracheal, urine, and pus samples. Risk factors included diabetes (40%), immune immune-compromised state (30%), use of broad-spectrum antibiotics (60%), malnutrition (10%), malignancies (20%), hemodialysis (5%), and recent surgery (70%). Several patients exhibited overlapping high-risk factors, indicating a higher cumulative risk for adverse health outcomes. Conclusion The study highlights the critical importance of stringent AMS and infection prevention and control (IPC) practices in ICUs to combat MDRO infections. Effective implementation of these measures can significantly reduce the spread of MDROs and improve patient outcomes. Enhancing training programs, improving technological infrastructure, developing standardized data protocols, and conducting community awareness campaigns are essential steps to address the identified challenges. Ensuring regular monitoring and evaluation will further enhance the effectiveness of these interventions.