Pattern of antibiotic resistance in nosocomial infections with Gram-negative bacilli in ICU patients (Tehran, Iran) during the years 2012-2014

Document Type: Research Paper


1 Department of Infectious Diseases and Tropical Medicine, Shahed University, Tehran, Iran

2 Medical Students Research Committee, Shahed University, Tehran, Iran

3 Tehran University of Medical Sciences, Emam Khomeini Hospital, Tehran, Iran

4 Shahed University, Tehran, Iran


Background and Objective: Owing to the new patterns of antibiotic resistance, selection of the appropriate antibiotics for the treatment of nosocomial infections, especially gram-negative bacilli, has become a big challenge. Therefore, the aim of this study was to evaluate the antibiotic resistance of nosocomial infections with Gram-negative bacilli in Iran during the years 2012-2014.
Materials and Methods: In this cross-sectional study, samples of the culture of patients with nosocomial infections in various departments of the Shahid Mostafa Khomeini hospital of Tehran were studied over a three-year period. Information on the culture-positive blood, urine, sputum, and exudates in terms of the presence of the most common nosocomial aerobic Gram-negative bacilli (Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae), the type of consumed antibiotics, and an antibiotic susceptibility test was extracted from patient records and recorded in the information forms.
Results: The percentage of P. aeruginosa resistance has increased during the study period as compared to the colistin, meropenem, imipenem, gentamicin, and ceftazidime antibiotics. A. baumannii and E. coli bacteria showed the highest resistance, while the maximum susceptibility was observed in this period to ampicillin and colistin. The high resistance of K. pneumoniae was also observed to cefotaxime and ampicillin, but this bacterium had a high susceptibility to colistin and meropenem.
Conclusion: The results obtained from the antibiotic resistance of the studied bacteria during the three years of the study demonstrates the increasing prevalence of the resistance of Gram-negative bacteria to common and available antibiotics. This could become a major clinical crisis in the near future.


  1. Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J. Harrison's Principle of Internal Medicine. McGraw-Hill: New York; 2012.
  2. Amini M, Vaseie M, Ansari I. The evaluation of nosocomial urinary tract infections and antimicrobial resistance in ICU patients, Tehran, Iran, 2012-2016. Acta Medica Mediterranea 2017; 33: 945-52.
  3. Petty W. Pacv-why hand washing is vital? J of perianesthesia nursing 2009; 24(4): 250-53.
  4. Patrick S, Kawai A, Kleinman K. Health care-associated infections among critically ill children in the US, 2007–2012. Pediatrics 2014; 8: 112-9.
  5. Bagheri Nejad S, Allegranzi B, Syed SB, Ellis B, Pittet D. Health-care-associated infection in Africa: a systematic review. Bull World Health Organ 2011;89-(10 ).
  6. Nazari R, Haji Ahmadi M , Saatsaz S, Rezaee R. Discrepancy between self-reported and observed and hygiene behaviour in healthcare professionals.journal of Mashad faculty of nursing and midwifery 2010; 10(2):31-7. [ Persian]
  7. Yokoe DS, Mermel LA, Anderson DJ, et al. A compendium of strategies to prevent healthcareassociated infections in acute care hospitals. Infection Control & Hospital Epidemiology 2008; 29 (l): 12–21.
  8. Stone PW, Hedblom EC, Murphy DM, Miller SB. The economic impact of infection control: making the business case for increased infection control resources. American Journal of Infection Control 2005;33: 542–547.
  9. Scott RD. The direct medical costs of healthcare-associated infections in US hospitals and the benefits of prevention, 2008. CDC. Available at Accessed: 7/1/2009.
  10. Gaynes R, Edwards JR. Overview of nosocomial infections caused by gram-negative bacilli. Clinical Infectious Diseases 2005; 41:848–854.
  11. Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infection Control & Hospital Epidemiology 2008; 29:996–1011.
  12. Peleg AY, Hooper D. Hospital acquired infections due to gram negative bacteria. The New England Journal of Medicine 2010; 362(19): 1804-13.
  13. Souli M, Galani I, Giamarellou H. Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe. Euro Surveillance 2008; 13(47):19045.
  14. Paterson DL, Lipman J. Returning to the pre-antibiotic era in the critically ill: the XDR problem. Critical Care Medicine 2007; 35:1789–1791.
  15. Valencia R, Arroyo LA, Conde M. Nosocomial outbreak of infection with pan-drug-resistant Acinetobacter baumannii in a tertiary care university hospital. Infection Control & Hospital Epidemiology 2009; 30:257–263.
  16. Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest 2000; 118:146–155.
  17. Akram M, Shahid M, Khan AU. Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in JNMC Hospital Aligarh, India. Annals of Clinical Microbiology and Antimicrobials 2007;6(1):4-9.
  18. Jafari S, Najafipour S, Kargar M, Abdollahi A, Mardaneh J, Fasihy Ramandy M, et al. Phenotypical Evaluation of Multi-Drug Resistant Acinetobacter Baumannii. Fasa University of Medical Sciences 2013;2(4):254-258. [Persian]
  19. Amini M, Vahidian M, Vaseie M, Gheini MH, Davati A. The evaluation of nosocomial infections and risk factors in ICU patients. International Journal of Pharmacy and Technology 2016;8(3): 18685-18693
  20. Mohammadimehr M, Feizabadi M, Bahadori A. Antibiotic resistance pattern of Gram negative Bacilli Caused nosocomial infections in ICUs in khanevadeh and golestan hospital in Tehran -2007. Annals of Military and Health Sciences Research 2011; 8 (4) :283-290. [Persian]
  21. Mohammadimehr M, Feizabadi M M, Bahadori O, Motshaker arani M, Khosravi M. Study of prevalence of gram- negative bacteria caused nosocomial infections in ICU in Besat hospital in Tehran and detection of their antibiotic resistance pattern-year 2007 . Iranian Journal of Microbiology 2009; 3 (2 and 3) :47-54. [Persian]
  22. Chen Y-Y, Chen L-Y, Lin SY, Chou P, Liao SY. Surveillance on secular trends of incidence and mortality for device-associated infection in the intensive care unit nter in Taiwan 2000-2008: A retrospective observational study. BMC Infectious Diseases 2012;12: 209.
  23. Mendes C, Oplustil C, Sakagami E, Turner P, Kiffer C; MYSTIC Brazil Group. Antimicrobial susceptibility in intensive care units: MYSTIC Program Brazil 2002. Brazilian Journal of Infectious Diseases 2005;9(1): 44-51.
  24. Jones RN, Pfaller MA, Doern GV, Erwin ME, Hollis RJ. Antimicrobial activity and Spectrum investigation of eight broad- spectrum beta- lactam drugs: Surveillance trial in 102 medical centers in the United States. Diagnostic Microbiology and Infectious Disease1998: 30 (3): 215-28.
  25. Hadadi A, Rasoulinejad M, Maleki Z, Yonesian M, Shirani A, Kourorian Z. Antimicrobial resistance pattern of Gramnegative bacilli of nosocomial origin at 2 university hospitals in Iran. Diagnostic Microbiology and Infectious Disease 2008;301–305.
  26. Amini M, Davati A, Golestanifard M. Frequency of nosocomial infections with antibiotic resistant strains of Acinetobacter spp. In ICU patient. Iranian Journal of Pathology 2012;7(4);p241-45.
  27. Hujer KM, Hujer AM, Hulten EA, Bajaksouzian S, Adams JM, Donskey CJ, et al. Analysis of antibiotic resistance genes in multi drug resistant Acintobacter spp. isolates from military and civilian patients treated at the Walter Reed Army Medical Center. Antimicrobial Agents and Chemotherapy 2006;50(12): 4114-23.
  28. Jain R, Danziger LH. Multidrug resistant Acinetobacter infections: an emerging challenge to clinicians. Annals of Pharmacotherapy 2004;38:1449-59.
  29. Iglesias de SH, Miron-Canelo JA, Fresnadillo Martinez MJ, Saenz Gonzalez MC. Epidemiological study and effect on antimicrobial use in the genus Acinetobacter in a university hospital. Rev Esp Quimioter 2004;17:177-183.
  30. Feizabadi MM, Fathollahzade B, Taherikhani M, Rasoolinejad M,Sadeghifard N, Aligholi M and et al. Antimicrobial Susceptibility Patterns and Distribution of blaOXA Genes among Acinetobacter spp. Isolated from Patients at Tehran Hospitals. Japanese Journal of Infectious Diseases 2008;61:274-278.
  31. Fallah M, Sharifian M, Moradi A, Malekan MA, Behzadnia H, Gholinejad Z. Antimicrobial Resistance of Urinary Tract Pathogens in Children on Peritoneal Dialysis. Iranian Journal of Infectious Diseases and Tropical Medicine 2008; 13(40):37-41. [Persian]
  32. Madani N, Rosenthal VD, Dendane T, Abidi KH, Zeggwagh A. Health-care associated infections rates, length of stay, and bacterial resistance in an intensive care unit of Morocco: Findings of the International Nosocomial Infection Control Consortium (INICC). International Archives of Medicine 2009; 2: 29-38