Carriage of multidrug-resistant bacteria and nosocomial infections in intensive care unit patients: Experience at Ibn Tofail Hospital

methods: This is a descriptive study conducted in the microbiology department of the Ibn Tofail Hospital at the Mohamed VI University Hospital in Marrakech over a four-month period from January to May 2024. It included biological and environmental samples received by the microbiology laboratory from patients hospitalized in the intensive care unit at Ibn Tofail Hospital who had developed nosocomial infections caused by multidrug-resistant (MDR) bacteria. Microorganism identification and antibiotic susceptibility testing were performed using standard bacteriological methods, supplemented by biochemical identification panels (BioMérieux, France). Antimicrobial resistance profiles were determined by the agar diffusion method, in accordance with EUCAST standards.

Results: During this period, 45 patients developed nosocomial infections within 48 hours of admission. The mean age of patients was 42 years, with a predominance of males (sex ratio = 2.46). All patients were exposed to at least one invasive procedure, such as tracheal intubation (97%), open surgery (93%), and arterial and urinary catheterization (91%).

The laboratory received 138 samples, with a positive culture rate of 75.4%. Multidrug-resistant bacteria were isolated in 68% of cases, mainly represented by imipenem-resistant Acinetobacter baumannii (IRAB) in 90 isolates (87%), followed by extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL) (13%). Enterobacter cloacae dominated ESBL-producing isolates with 48%, followed by Escherichia coli (35%) and Klebsiella pneumoniae (17%).

A total of 180 samples were collected from the patients' environment. Seventy-two of the samples from the patients' environment were positive (40%) for MDR bacteria. Bed rails had the highest number of positive samples (38%), followed by the respiratory system (29%) and door handles (19%). Imipenem-resistant Acinetobacter baumannii was predominant (96%).

Conclusion: Detecting multidrug-resistant bacterial colonization plays a key role in controlling and preventing healthcare-associated infections. Strengthening surveillance systems, improving diagnostic techniques, and raising awareness among healthcare workers are essential strategies for mitigating the impact of antimicrobial resistance and ensuring better outcomes for patients.