Gut colonization with multidrug-resistant organisms in hospitalized patients with gastrointestinal illness: A...

Gut colonization with multidrug-resistant organisms (MDRO) is associated with poor outcomes in hospitalized patients. This cross-sectional study determined prevalence of MDRO colonization among patients admitted in gastroenterology ward and intensive care unit (ICU) at All India Institute of Medical Sciences, New Delhi.

Rectal swabs for bacterial culture were obtained at a single time point from consecutive patients over two-month period (October-November 2022). Isolates were tested for antibiotic sensitivity using VITEK 2 compact (bioMérieux Inc., Marcy-L'Étoile, France) and anti-microbial resistance (AMR) genes by polymerase chain reaction (PCR) (Bio-Rad^TM). Prevalence of MDRO in other clinical samples and concordance between fecal and other samples were also assessed.

Among 107 patients (mean age 40.3 ± 14.8 years, 27.1% females, 41.1% chronic liver disease, 27.1% acute pancreatitis, 31.8% other gastrointestinal diseases), median hospitalization duration at the time of collecting rectal swab was nine (6-17.5) days, with 59.2%, 52.5% and 22.5% requiring central venous catheterization, Foley catheterization and mechanical ventilation, respectively. MDRO colonization was detected in 106 (99.1% [95% CI = 94.9-99.9%]) samples, predominantly Escherichia coli (75.7%), Klebsiella pneumoniae (16.8%) and Enterococcus fecium (9.3%). NDM (New Delhi metallo-β-lactamase, carbapenemase, 64.5%) was the most prevalent AMR gene, followed by TEM (extended-spectrum-beta-lactamase, 58.9%) and OXA (carbapenemase, 55.1%). Fifteen per cent of other clinical samples were positive for MDRO, most commonly K. pneumoniae (50%). Concordance for MDRO was highest in acute pancreatitis (16.7% for E. coli, 33.3% for K. pneumoniae). Isolated gut MDRO colonization was associated with 22% (n = 20) mortality, while patients with MDRO in both stool and another clinical sample had 50% (n = 8) mortality.

We report extremely high prevalence of gut colonization with MDROs in hospitalized patients with gastrointestinal illness. These findings highlight the need for stringent infection control practices, anti-microbial stewardship and surveillance strategies to prevent MDRO transmission and adverse clinical outcomes. Larger, multi-centre studies are needed to confirm these findings.