IDENTIFYING THE RISK FACTORS FOR INFECTION WITH MULTIDRUG-RESISTANT GRAM-NEGATIVE PATHOGENS: A CASE CONTROL STUDY FROM AYUB TEACHING HOSPITAL & MUSHARRAF MEDICAL COMPLEX, PAK.

Abstract

Background: The rising prevalence of multidrug-resistant (MDR) Gram-negative bacteria (GNB) in healthcare settings poses a significant challenge to infection control and patient safety. This study aims to identify key risk factors associated with MDR infections caused by pathogens such as Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli. Understanding these risk factors is crucial for developing effective containment strategies and guiding healthcare professionals in implementing targeted infection control measures. Additionally, recognizing patterns of resistance can aid in optimizing antimicrobial stewardship programs and improving patient outcomes.

Methods: A case-control study was conducted at Ayub Teaching Hospital and Musharraf Medical Complex, Abbottabad, to evaluate the risk factors associated with multidrug-resistant (MDR) Gram-negative bacterial infections in hospitalized patients. The study included two groups: 200 patients with healthcare-associated infections (HAIs) due to MDR Gram-negative bacteria and 200 patients with HAIs caused by non-MDR Gram-negative bacteria (organisms not meeting MDR criteria). HAIs were defined as infections developing 48 hours or more after hospital admission. MDR bacteria were categorized as those resistant to at least one antibiotic in three or more antimicrobial classes. Data were analyzed using descriptive statistics to determine the frequency and percentage distribution of categorical variables. Multivariate regression analysis was applied to identify independent risk factors for MDR infections, with statistical significance set at a p-value of <0.05.

Results: Over a four-month period (March–June 2024), a total of 529 bacterial isolates were recovered from 452 hospitalized patients at Ayub Teaching Hospital and Musharraf Medical Complex, Abbottabad. Among these patients, 77(17%) had polymicrobial infections caused by more than one pathogen.Among the multidrug-resistant (MDR) isolates, Acinetobacter baumannii was the most prevalent (38%), followed by Klebsiella pneumoniae (31%, ), Pseudomonas aeruginosa (20%), and Escherichia coli (11%). Conversely, among the non-MDR isolates, Pseudomonas aeruginosa was the most frequently identified (47%), followed by Escherichia coli (32%), Klebsiella pneumoniae (18%,), and Acinetobacter baumannii (3%).A comparative analysis between MDR-infected patients and those infected with non-MDR organisms revealed that prior antibiotic use (p = 0.001), intensive care unit (ICU) admission (p = 0.001), and the presence of indwelling medical devices (p = 0.005) were significant predictors of MDR infections. These findings highlight the critical role of antimicrobial stewardship and infection control measures in limiting the emergence and spread of MDR pathogens in hospitalized patients.

Conclusion: The findings underscore the growing threat of MDR infections in Pakistani hospitals, where excessive antibiotic use, prolonged hospitalization, and inadequate infection control practices contribute to the problem. By minimizing unnecessary antibiotic use, improving hospital hygiene, and ensuring strict adherence to infection prevention protocols—especially in high-risk areas like intensive care units—healthcare facilities in Pakistan can reduce the burden of MDR infections. Strengthening surveillance systems and promoting awareness among medical staff can further aid in controlling the emergence and transmission of these resistant pathogens, ultimately improving patient safety and treatment outcomes.