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Trends and drivers of multidrug-resistant bacteria incidence in 59 Chilean intensive care units, 2015-2024: a
Maria-Paz Acuña1,2,3, Patricio Ross1,4, Gerardo Carcamo1,5
1Department of Infectious Diseases, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.
Background:
Antimicrobial resistance (AMR) is a major threat in intensive care units (ICUs). Evidence on determinants of multidrug-resistant (MDR) infections in ICUs remains limited. We aimed to assess temporal, institutional, and antibiotic-use drivers of MDR incidence across 59 Chilean ICUs across 40 hospitals (2015-2024).
Methods:
We conducted an ecological time-trend analysis using data from the Collaborative Group on Bacterial Resistance. MDR incidence density rates (IDRs) in 1000 patient-days comprised methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli, carbapenem-resistant Enterobacterales (CRE), Pseudomonas aeruginosa (CRPA), Acinetobacter baumannii (CRAB), and carbapenemase-producing Enterobacterales (CPE). IDRs were modelled using three-level Bayesian hierarchical regressions, accounting for repeated annual measures within hospital-pathogen pairs and differences between hospitals. Models included hospital infrastructure, infectious disease specialist hours, antimicrobial stewardship (AMS) programmes, socioeconomic variables, and antibiotic use (cephalosporins, quinolones, carbapenems; in DDDs/1000 bed-days).
Findings:
Between 2015 and 2024, MDR incidence declined by 21% (1.82-1.44 per 1000 patient-days), driven by reductions in CRPA (4.8-1.9), MRSA (3.2-1.0), and VRE (1.4-0.9). CRE declined modestly (2.7-1.7), while CPE increased from 0 to 1.3 after 2017. Adult ICUs and public hospitals had higher IDRs than paediatric and private units. In adjusted models, quinolone use was associated with higher MDR incidence (β = 0.08, 95% CI 0.03-0.14; p = 0.004), as was carbapenem use (β = 0.06, 0.03-0.09; p < 0.0001). Each additional hour of infectious disease specialist coverage per 100 bed-days reduced MDR incidence by ∼2% (β = -0.02, -0.03 to -0.01; p = 0.023). MRSA increased with quinolones, while CRE and CRPA increased with carbapenems.
Interpretation:
MDR incidence in Chilean ICUs remains high and driven by quinolone and carbapenem use. Strengthening AMS and specialist oversight, alongside stricter prescribing, could reduce burdens.
Funding:
No funding.
Insights
Multidrug-resistant infections in Chilean intensive care units (ICUs) declined but remain high, driven by specific antibiotic use. Enhancing antimicrobial stewardship and specialist oversight is crucial for reducing resistance.
Area of Science:
- Infectious Diseases
- Public Health
- Healthcare Epidemiology
Background:
- Antimicrobial resistance (AMR) poses a significant threat in intensive care units (ICUs).
- Limited evidence exists on the drivers of multidrug-resistant (MDR) infections within ICUs.
- This study investigates temporal, institutional, and antibiotic-use factors influencing MDR incidence in Chilean ICUs.
Purpose of the Study:
- To assess temporal trends in MDR incidence across Chilean ICUs from 2015 to 2024.
- To identify institutional and antibiotic-use determinants associated with MDR infections.
- To inform strategies for combating AMR in critical care settings.
Main Methods:
- Ecological time-trend analysis of MDR incidence density rates (IDRs) in 59 Chilean ICUs.
- Bayesian hierarchical regression models incorporating hospital infrastructure, specialist hours, antimicrobial stewardship (AMS), socioeconomic factors, and antibiotic consumption.
- Analysis included key pathogens like MRSA, VRE, ESBL-producers, CRE, CRPA, CRAB, and CPE.
Main Results:
- Overall MDR incidence decreased by 21% (1.82 to 1.44 per 1000 patient-days) between 2015-2024, notably driven by reductions in CRPA, MRSA, and VRE.
- Carbapenem-resistant Enterobacterales (CRE) showed a modest decline, while carbapenemase-producing Enterobacterales (CPE) increased post-2017.
- Quinolone and carbapenem use were significantly associated with higher MDR incidence, while increased infectious disease specialist coverage correlated with reduced MDR rates.
Conclusions:
- Despite a decline, MDR incidence in Chilean ICUs remains a concern, strongly linked to quinolone and carbapenem consumption.
- Targeted interventions focusing on antimicrobial stewardship programs and specialist oversight are essential.
- Stricter antibiotic prescribing guidelines are recommended to mitigate the burden of MDR infections.
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