Prevalence of Multidrug Resistance Gram Negative Bacteria among Patients with Bacteremia in Erbil, Iraq

Background: The presence of microorganisms in a patient's blood is a critical determinant of the severity of the patient's illness and its complication is one of the main infective causes of mortality and morbidity. Early and prompt antibiotic therapy based on the knowledge of the prevalent microorganisms can help reduce this rate.

Objectives: Our study aimed to carry out prevalence study on bacteremia isolated from blood samples among patients in Erbil city and analyze its antibiotics susceptibility pattern test and multi-drug resistance.

Materials and Methods: A total of 1023 from 2015 until 2021 bacteremia were isolated from patients blood samples attending (Nanakali, Raparin, Maryamana) hospitals and BIO lab from both male and female. Only 57 cases had been identified as bacteremia isolates which were identified by using microscopical, macroscopical identification, cultural, BacT/ALERT and vitek 2 compact system. Also antibiotic susceptibility test was performed by vitek 2 compact on 13 antibiotics.

Results: Only 57 bacteremia isolates were isolated from 1023 samples from (2015-2021), in our study the percentage of females infected with bacteremia were more than the males, females being 29/1023 (2.84%) and males being 28/1023 (2.74%), about the age groups in (2015-2021) infections by bacteremia were increased in (21-30) age people being 13/57 ( 22.81%) in total, in (2015-2021) the most common bacteria that cause bacteremia were Escherichia coli being 28/57(49.12%) followed by Klebsiella pneumonia being 11/57 (19.3%) , Enterobacter spp. being 7/57 (12.28%) , Salmonella typhi and Serratia marcescens both had 1/57 (1.75%) , Acinetobacter baumanni had 7/57 (12.3%) and finally Pseudomonas aeruginosa had 2/57 (3.5%) . Escherichia coli this bacteria mainly found in females 16/28 (57.14%), in ( 2015-2021), for cancer patients with bacteremia Escherichia coli was the most common isolated bacteria being 24/732 (3.30%), bacteremia mostly infected patients with acute myeloid leukemia were 12/38(31.58%) in Nanakali hospital, the bacteria that isolated from patients with bacteremia had resistance to more than three classes of antibiotics they were highly resistance to vancomycin 15 (100%), tetracycline12 (80%) followed by sulfamethoxazole 11 (73.33%) then to erythromycin 9 (60%) and both amoxicillin and clindamycin had 8 (53.33%) antibiotic resistance.

Conclusions: The study showed that the rate of bacteremia increased in last few years in Erbil city especially in cancer patient and those having weak immunity, bacteria acquired resistance to antibiotics and this due to frequent use of antibiotics, morbidity attribute to antibiotic resistant is significant, if prevailing resistance trends continue, high societal and economic costs can be expected. Better management of antibiotic use, and infection control is needed to avoid infections that caused by drug resistant pathogens bacteremia.