Risk factors associated with carbapenem-resistant Gram-negative bacterial infections in intensive care units in...

Carbapenem-resistant Gram-negative bacteria (CR-GNB) pose major challenges in intensive care units (ICUs) due to limited treatment options and high mortality. Data describing their predictors in Jordan are scarce. This study aimed to identify risk factors associated with CR-GNB infections among ICU patients.

A retrospective analysis was conducted using national surveillance data from 18 ICUs across 13 public hospitals in Jordan between September 2018 and September 2024. Patients with confirmed Gram-negative infections were included. Laboratory testing followed CLSI M100 standards. Logistic regression was performed to determine independent predictors of carbapenem resistance.

Of 1,180 Gram-negative isolates tested, 451 (38%) were carbapenem-resistant. Acinetobacter baumannii and Klebsiella spp. were the predominant resistant pathogens, while E.coli was mainly carbapenem-susceptible. Independent predictors of carbapenem resistance identified by multivariate logistic regression were: ICU-acquired infection (OR: 2.44; 95% CI: 1.31-4.54; p = 0.004), pneumonia (OR: 2.77; 95% CI: 1.48-5.23; p = 0.001), invasive device use (OR: 3.37; 95% CI: 1.28-9.95; p = 0.019), and admission to high-risk ICU units (OR: 3.33; 95% CI: 2.06-5.48; p < 0.001). Mortality was significantly higher among CR-GNB patients (69.8%) compared to carbapenem-susceptible patients (42.0%), with a 3.15-fold increased risk of death (OR: 3.149; 95% CI: 2.392-4.145; p < 0.001).

The findings of this study underscore the need for strategies to prevent and control carbapenem-resistant infections, particularly in high-risk populations such as patients with invasive devices and those diagnosed with pneumonia. Enhanced infection control measures, including strict hand hygiene practices, judicious antibiotic stewardship, and proper management of invasive devices, are essential to minimize the transmission of carbapenem-resistant bacteria in healthcare settings.