| dc.description.abstract |
Background: Antimicrobial resistance (AMR) is a global public health threat associated with
poor patient outcome, treatment failure and high cost. We now encounter patients, particularly
those admitted to intensive care units (ICU), harboring difficult to treat pathogens but there are
major gaps in routine surveillance, antimicrobial susceptibility testing (AST) and reporting. The
effect of AMR on patient outcome has been inconsistent.
Objective: To identify commonly isolated pathogens, their antimicrobial resistance pattern and
clinical outcome of patients admitted to the ICU of Tikur Anbessa Specialized Hospital (TASH).
Methods: An institution based 6 months retrospective cross sectional study conducted in the
ICU of TASH on 216 patients. Data regarding sociodemographic and clinical characteristics,
AST and outcome of patients was collected from the health management information system
(HMIS). Statistical package for social science (SPSS) version 27 was used for data analysis.
Categorical data was described in percentages and mean. Bivariate and multivariate logistic
regression was used to assess the association between AMR and intra ICU mortality. P value of
< 0.05 was considered statistically significant.
Results: All infections were mono microbial and bloodstream infection was the commonest.
89.4% of infections were due to gram negative bacteria. Of the gram negatives the most
commonly isolated pathogen was Acinetobacter baumannii (31.5%) with carbapenem resistance
acinetobacter baumannii (CRAB) infection being predominant. Multidrug resistance (MDR) was
seen in 80.1% of the isolates. Intra ICU mortality from MDR infection was 56.1% and it was
determined to have a significant association with bloodstream infection (AOR 2.89 95% CI 1.11,
3.94), septic shock (AOR 5.34 95% CI 2.32, 12.25), CRAB infection (AOR 2.22 95%CI 1.11,
4.43) and surgical intervention (AOR 0.46 95%CI 0.24, 0.88).
Conclusion: Gram negative bacteria are the commonest isolated pathogens in the ICU with most
exhibiting high degree of resistance against the majority of antimicrobials. Blood stream
infection, septic shock, medical cases and CRAB infection were determined to be predictors of
intra ICU mortality.
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