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Peer-reviewedCC BY-NC-NDInfection prevention in practice

Burden and risk factors of acquisition of multi-drug-resistant Gram-negative bacteria among intensive care patients at a tertiary care setting.

  • Majid M Alshamrani1,2,3,4
  • Aiman El-Saed1,2,3,5
  • Jaffar A Al-Tawfiq6
  • Fatmah Othman2,3
  • Kholod M AlAmeer1
  • Sarah Al-Fayez1
  • Ghada O Elkhawaga5,7
  • Mohammed Al Zunitan1,2,4
  • Fayssal Farahat1,2
7 affiliations
  1. 1Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
  2. 2King Saud bin Abdulaziz University for Health Sciences, Riyadh Saudi Arabia.
  3. 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
  4. 4Infection Prevention and Control Department, King Abdullah Specialized Children's Hospital Riyadh, Saudi Arabia.
  5. 5Community Medicine and Public Health Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
  6. 6Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
  7. 7Department of Family and Community Medicine, College of Medicine, Jouf University, Sakaka, Saudi Arabia.
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Abstract

Introduction

Multi-drug-resistant Gram-negative bacteria (MDR-GNB) are a major healthcare challenge, particularly among patients admitted to intensive care units (ICUs). The objective of the current study was to assess the risk of acquisition of MDR-GNB in ICU patients and the associated risk factors and outcomes.Methods

A prospective cohort study among adult ICU patients was conducted in two tertiary care hospitals in Riyadh, Saudi Arabia, between 2021 and 2022. Specimens were examined at admission, during stay, and before discharge for all patients. Acquisition of MDR-GNB was confirmed by a positive culture/polymerase chain reaction before discharge among patients who were negative at admission.Results

A total of 307 patients were included. The mean age was 56.7 ± 18.2 years and 62.2% were males. Out of 307, 82 (26.7%) patients acquired MDR-GNB during their ICU stay. The most common MDR-GNB pathogens were Klebsiella spp. (47.1%), Acinetobacter spp. (14.7%), Pseudomonas aeruginosa (12.7%), Enterobacter spp. (10.8%), and Escherichia coli (5.9%). Approximately 40.2% of MDR-GNB presented as infection and 59.8% as colonization. In multi-variate analysis, the following variables were independent predictors of MDR-GNB acquisition; pneumonia at admission, central line use, urinary catheter use, renal comorbidity, and prolonged hospitalization. Patients who acquired MDR-GNB had significantly higher mortality (34.1% vs 5.3%, P<0.001) and ICU length of stay (median of 26 vs 10 days, P<0.001).Conclusions

The findings underscore the high risk and burden of MDR-GNB acquisition in the ICU setting. There is an urgent need for enhanced infection control strategies and antimicrobial stewardship activities to reduce MDR-GNB acquisition and its negative impact.

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Cite

BibTeXRIS
BibTeX
@article{alshamrani2026burden,
  title = {{Burden and risk factors of acquisition of multi-drug-resistant Gram-negative bacteria among intensive care patients at a tertiary care setting.}},
  author = {Majid M Alshamrani and Aiman El-Saed and Jaffar A Al-Tawfiq and Fatmah Othman and Kholod M AlAmeer and Sarah Al-Fayez and Ghada O Elkhawaga and Mohammed Al Zunitan and Fayssal Farahat},
  journal = {Infection prevention in practice},
  year = {2026},
  month = aug,
  doi = {10.1016/j.infpip.2026.100579},
  url = {https://europepmc.org/article/MED/42898838},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - Burden and risk factors of acquisition of multi-drug-resistant Gram-negative bacteria among intensive care patients at a tertiary care setting.
AU  - Majid M Alshamrani
AU  - Aiman El-Saed
AU  - Jaffar A Al-Tawfiq
AU  - Fatmah Othman
AU  - Kholod M AlAmeer
AU  - Sarah Al-Fayez
AU  - Ghada O Elkhawaga
AU  - Mohammed Al Zunitan
AU  - Fayssal Farahat
PY  - 2026
DA  - 2026/08/07
JO  - Infection prevention in practice
DO  - 10.1016/j.infpip.2026.100579
UR  - https://europepmc.org/article/MED/42898838
AB  - Introduction  Multi-drug-resistant Gram-negative bacteria (MDR-GNB) are a major healthcare challenge, particularly among patients admitted to intensive care units (ICUs). The objective of the current study was to assess the risk of acquisition of MDR-GNB in ICU patients and the associated risk factors and outcomes.Methods  A prospective cohort study among adult ICU patients was conducted in two tertiary care hospitals in Riyadh, Saudi Arabia, between 2021 and 2022. Specimens were examined at admission, during stay, and before discharge for all patients. Acquisition of MDR-GNB was confirmed by a positive culture/polymerase chain reaction before discharge among patients who were negative at admission.Results  A total of 307 patients were included. The mean age was 56.7 ± 18.2 years and 62.2% were males. Out of 307, 82 (26.7%) patients acquired MDR-GNB during their ICU stay. The most common MDR-GNB pathogens were Klebsiella spp. (47.1%), Acinetobacter spp. (14.7%), Pseudomonas aeruginosa (12.7%), Enterobacter spp. (10.8%), and Escherichia coli (5.9%). Approximately 40.2% of MDR-GNB presented as infection and 59.8% as colonization. In multi-variate analysis, the following variables were independent predictors of MDR-GNB acquisition; pneumonia at admission, central line use, urinary catheter use, renal comorbidity, and prolonged hospitalization. Patients who acquired MDR-GNB had significantly higher mortality (34.1% vs 5.3%, P<0.001) and ICU length of stay (median of 26 vs 10 days, P<0.001).Conclusions  The findings underscore the high risk and burden of MDR-GNB acquisition in the ICU setting. There is an urgent need for enhanced infection control strategies and antimicrobial stewardship activities to reduce MDR-GNB acquisition and its negative impact.
SN  - 2590-0889
ER  -