Investigating the Extent and Treatment of Infections Caused by ESKAPE Pathogens in an Intensive Care Unit

Abstract

Background: The ESKAPE acronym represents six multi-drug-resistant bacterial pathogens that account for a large proportion of healthcare-associated infections. Antimicrobial resistance surveillance provides information about the extent and prevalence of antimicrobial resistance. This information can be used to provide guidance on appropriate antimicrobial treatment. Rectal swab screening is another intervention that may assist in choosing empiric antimicrobial treatment. Aim: The aim of this study was to investigate the extent and treatment of infections caused by ESKAPE pathogens in an intensive care unit (ICU) at a public hospital in Johannesburg, and to determine whether rectal swab screening for bacterial colonization leads to earlier initiation of appropriate antimicrobial therapy. Methods: A cross-sectional, retrospective, records review was conducted at the ICU at Charlotte Maxeke Johannesburg Academic Hospital. The study involved records review of all patients admitted to the ICU from September 2021 to September 2022. This retrospective study used National Health Laboratory Service data. Results: Of the 690 patients admitted to the ICU during the study period, one or more of the ESKAPE pathogens were isolated from 132 patients. The most common sample type collected from patients was blood cultures (33.9%, n = 259) with the most frequent ESKAPE pathogen being Klebsiella pneumoniae (n=38) followed by Acinetobacter baumannii (n=29) and Escherichia coli (n=12). Only 48.5% of patients received appropriate empiric antimicrobial therapy. Rectal swab screening was performed in 91 (69%) of the patients. Conclusion: The most common specimen type was blood cultures (44.9%), and the most frequently isolated ESKAPE pathogen from blood cultures was K. pneumoniae followed by A. baumannii and E. coli. These findings are similar to findings from studies in other lower- middle income countries. There was a lack of other studies on the ESKAPE pathogens found in the other specimen types, indicating a need for future studies on the prevalence and resistance of ESKAPE pathogens across the various specimen types. Commonly prescribed antimicrobial treatments included piperacillin-tazobactam, amoxicillin-clavulanic acid and carbapenems. vi The findings revealed a higher usage of carbapenems than in other studies, which could be accounted for by the high prevalence of ESBL-producing Enterobacterales. The rectal swab screening data was sparse, and a longer more inclusive study would be valuable to draw more meaningful conclusions on the impact of screening using rectal swabs.