Introduction: In recent years, an increase in healthcare-associated infections (HAIs) caused by resistant pathogens, which is a clinically troublesome trend, has been observed. The aim of the study was to analyze the microbial factors of HAIs and the drug resistance of microorganisms to selected antibiotics and their consumption. Material and Methods: The retrospective study included 3708 patients hospitalized in the intensive care unit (ICU) of the University Teaching Hospital in Wroclaw, who were diagnosed with 742 HAIs in the period from 1 January 2011 to 31 December 2018. The aim of the study was the analysis of microorganisms isolated in the respective clinical forms of HAIs, including the occurrence of “alert pathogens”, presence of multidrug-resistant (MDR) strains, and consumption of selected antibiotics. Findings: During the study period, 846 microorganisms were cultured in patients with HAIs, and among them, Acinetobacter baumannii MDR represented 31.8%; Klebsiella pneumoniae ESBLs, 11.3%; Pseudomonas aeruginosa MDR, 4.1% and MRSA, 2.2%; and Enterococcus spp. vancomycin-resistant enterococci (VRE), 1.3%. Among all the pathogens, Gram-negative bacteria (GNB) were dominant (71.6%). Gram-positive bacteria and fungi accounted for 21.6% and 7%, respectively. The total number of strains responsible for ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and central line-associated blood stream infection (CLA-BSI) was as follows: 458 (54.1%), 274 (32.4%), and 114 (13.5%), respectively. Among the etiological factors of VAP, there was a prevalence of A. baumannii MDR (41.9%), as well as in the case of UTI (21.9%). With regards to CLA-BSI, MRCNS (29.8%) was the dominant pathogen. The “alert pathogens” accounted for 54.7% of all the analyzed strains. The MDR strains represented 72.6% and 9.7% among A. baumannii and P. aeruginosa, respectively. In the years 2011 vs. 2018, an increase in infections with MDR bacilli was observed, 34.6% vs. 61.0% (p = 0.0008), respectively, including A. baumannii MDR 16.54% vs. 34.56 % (p = 0.0009) and Enterobacterales ESBL+/AMPC 11.8% vs. 15.44 % (p = 0.3921). Resistance to methicillin was confirmed in 35.2% of S. aureus strains. Resistance to vancomycin was found among 30.9% of Enterococcus spp. The observed period was marked by an increase in the consumption of carbapenems: 197.7 vs. 235.9 defined daily dose (DDD)/1000 patients-days. Conclusions: Gram-negative bacteria were found to be dominant pathogens in healthcare-associated infections. The most frequently cultured pathogens were multidrug-resistant A. baumannii, K. pneumoniae ESBL(+), and P. aeruginosa. The study showed an increase in the incidence of “alert pathogens” and MDR bacilli, as well as the tendency of a growing resistance to antibiotics during the observed period. Microbiological analysis of HAIs and the consumption of antibiotics is the necessary element of the proper antibiotic policy in hospitals.

中文翻译：

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2011-2018年波兰大学重症监护病房与医疗保健相关的感染（包括耐多药病原体和抗生素消耗量）的微生物因素的特征

简介：近年来，已观察到由耐药菌引起的医疗保健相关感染（HAI）的增加，这是一种临床上令人困扰的趋势。该研究的目的是分析HAIs的微生物因素以及微生物对所选抗生素及其消费的耐药性。材料与方法：回顾性研究包括2011年1月1日至2018年12月31日期间在弗罗茨瓦夫大学教学医院重症监护病房（ICU）住院的3708例患者，他们被诊断出742个HAI。在HAIs的各个临床形式中分离出的微生物，包括“警惕病原体”的出现，多药耐药（MDR）菌株的存在以及所选抗生素的消费。结果：在研究期间，HAIs患者共培养了846种微生物，其中鲍曼不动杆菌MDR占31.8％；鲍曼不动杆菌MDR占31.8％。肺炎克雷伯菌ESBLs，11.3％；铜绿假单胞菌MDR（4.1％）和MRSA（2.2％）；和肠球菌spp。耐万古霉素肠球菌（VRE），1.3％。在所有病原体中，革兰氏阴性菌（GNB）占主导地位（71.6％）。革兰氏阳性细菌和真菌分别占21.6％和7％。引起呼吸机相关性肺炎（VAP），泌尿系统感染（UTI）和中线相关血流感染（CLA-BSI）的菌株总数如下：458（54.1％），274（32.4％） ，和114（13.5％）。在VAP的病因中，鲍曼不动杆菌的MDR（41.9％）以及UTI的患病率（21.9％）。就CLA-BSI而言，MRNCS（29.8％）是主要病原体。“警报病原体”占所有分析菌株的54.7％。在鲍曼不动杆菌和铜绿假单胞菌中，MDR菌株分别占72.6％和9.7％。在2011年和2018年之间，p = 0.0008），分别包括鲍曼不动杆菌MDR 16.54％对34.56％（p = 0.0009）和肠杆菌ESBL + / AMPC 11.8％对15.44％（p = 0.3921）。在35.2％的金黄色葡萄球菌菌株中证实了对甲氧西林的抗性。在肠球菌的30.9％中发现对万古霉素有抗性。观察到的时期的特点是碳青霉烯的消耗量增加：每千名患者每天确定的每日剂量（DDD）为197.7与235.9。结论：革兰氏阴性细菌是医疗相关感染中的主要病原体。培养最频繁的病原体是多重耐药性鲍曼不动杆菌，肺炎克雷伯菌ESBL（+）和铜绿假单胞菌。该研究表明，“警惕病原体”和耐多药结核杆菌的发病率增加，并且在观察期内对抗生素的耐药性呈上升趋势。HAIs的微生物学分析和抗生素的消耗是医院适当抗生素政策的必要组成部分。