Risk Factors Associated with Antibiotic Multidrug Resistant Nosocomial Infection among Hospitalized Patients Aged 14 years and Older in Nakhon Phanom Hospital

Abstract

Objectives: Multiple drug-resistant infections can cause patient’s death, or result in longer hospital stays, higher treatment costs and require expensive antibiotics. The aims of this study was to determine the risk factors associated with antibiotic multiple drug-resistant infections among hospitalized patients aged 14 years and over and incidence of antibiotic multiple drug-resistant infections among patients in Nakhon Phanom Hospital. Materials and Methods: A case-control study was conducted among hospitalized patients in Nakhon Phanom Hospital between January 2016 and December 2018 to compare factors associated with antibiotic multidrug resistance between multiple drug-resistant patients with 1-2 groups of drug-resistant patients and non-drug-resistant infections. Data was collected from in-patient charts. Factors studied included sex, age, diabetes and cancer patients, treatment in intensive care unit, having insertion tubes or catheters into the body including endotracheal tube, urine catheter, nasogastric tube, and receiving antimicrobial drugs. Multivariable logistic regression was used for statistical analysis. Result: A total of 461 patients were enrolled: 117 cases and 344 controls. Most of the cases were female (58%), with a mean age of 62 years, had ventilator-associated pneumonia infection (58.1%), most common pathogen being Acinetobacter baumannii (83%), and had an average stay in hospital of 33 days. In the control group, a majority were male (52%), with a mean age of 59 years, had catheter- associated urinary tract infection (32%), most common pathogen being Escherichia coli (22%), and an average stay in hospital of 25 days. Both groups had different outcomes which were statistically significant: 63% improved and 21% died in the case group, while 79% improved and 13% died in the control group. Incidence rate of multidrug resistant infection in 2016, 2017, and 2018 were 0.11%, 0.12%, and 0.16% respectively. Risk factors for antibiotic multiple drug-resistant infections included treatment in intensive care (OR adjusted 1.83, 95%CI 1.00-3.35), intubation with endotracheal tube (aOR 2.47, 95%CI 1.10-5.55) and having received 3rd generation Cephalosporins (aOR 1.92, 95%CI 1.21-3.05). Conclusion: Patients in intensive care unit together with endotracheal tube and receiving 3rd Cephalosporin drugs have a higher chance of antibiotic multiple drug-resistant infections. Studies with more data are needed to better understand the risk factors associated with antibiotic multidrug resistant nosocomial infections in hospital settings.