Risk factors and prevention and control strategies for hospital-acquired multidrug-resistant bacterial infections in intensive care unit patients_West China Medical Journal

Authors：

SHEN Wanzhu ¹ , CHENG Jun ² ,  YIN Jun ^1,2

1. Department of Infection Control, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230001, P. R. China;
2. Department of Infectious Diseases, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230001, P. R. China;

Corresponding author：

YIN Jun, Email: dongdanfu@163.com

Keywords：

Intensive care unit; multidrug-resistant bacteria; hospital-acquired infection

DOI：

10.7507/1002-0179.202502018

Video：

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Abstract Full text Figures/Tables Video References Cited by

Multidrug-resistant bacterial infection is one of the important causes of death in intensive care unit (ICU) patients, which can significantly increase the length of hospital stay and treatment costs for ICU patients. At present, domestic scholars have paid less attention to hospital-acquired multidrug-resistant bacterial infection in ICU patients. This article summarizes the clinical manifestations, risk factors, and prevention and control measures of hospital-acquired multidrug-resistant bacterial infection in ICU patients, aiming to improve the understanding of medical staff on the situation of hospital-acquired multidrug-resistant bacterial infection in ICU and promote the development of hospital infection prevention and control.

Citation： SHEN Wanzhu, CHENG Jun, YIN Jun. Risk factors and prevention and control strategies for hospital-acquired multidrug-resistant bacterial infections in intensive care unit patients. West China Medical Journal, 2025, 40(3): 348-353. doi: 10.7507/1002-0179.202502018 Copy

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2.	Barrasa-Villar JI, Aibar-Remón C, Prieto-Andrés P, et al. Impact on morbidity, mortality, and length of stay of hospital-acquired infections by resistant microorganisms. Clin Infect Dis, 2017, 65(4): 644-652.
3.	Wp SE, Norhidayah M, Ar MNA. Factors associated with multidrug-resistant organism (MDRO) mortality: an analysis from the national surveillance of multidrug-resistant organism, 2018-2022. BMC Infect Dis, 2025, 25(1): 60.
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9.	Ramirez CB, Cantey JB. Antibiotic resistance in the neonatal intensive care unit. Neoreviews, 2019, 20(3): e135-e144.
10.	Flannery DD, Chiotos K, Gerber JS, et al. Neonatal multidrug-resistant gram-negative infection: epidemiology, mechanisms of resistance, and management. Pediatr Res, 2022, 91(2): 380-391.
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1. Nelson RE, Hyun D, Jezek A, et al. Mortality, length of stay, and healthcare costs associated with multidrug-resistant bacterial infections among elderly hospitalized patients in the United States. Clin Infect Dis, 2022, 74(6): 1070-1080.
2. Barrasa-Villar JI, Aibar-Remón C, Prieto-Andrés P, et al. Impact on morbidity, mortality, and length of stay of hospital-acquired infections by resistant microorganisms. Clin Infect Dis, 2017, 65(4): 644-652.
3. Wp SE, Norhidayah M, Ar MNA. Factors associated with multidrug-resistant organism (MDRO) mortality: an analysis from the national surveillance of multidrug-resistant organism, 2018-2022. BMC Infect Dis, 2025, 25(1): 60.
4. Pendleton JN, Gorman SP, Gilmore BF. Clinical relevance of the ESKAPE pathogens. Expert Rev Anti Infect Ther, 2013, 11(3): 297-308.
5. 田华. 多重耐药菌临床分布特点研究. 中国继续医学教育, 2021, 13(17): 142-145.
6. 孙桂英, 倪晓艳, 方国兰, 等. 三级综合医院常见多重耐药菌医院感染的临床特点及耐药性分析. 临床合理用药, 2024, 17(34): 189-192, 封 3.
7. 刘超梅, 闫晓芳, 宿瑞俊, 等. 临床常见多重耐药菌分布特点及耐药性. 中国国境卫生检疫杂志, 2024, 47(1): 92-95.
8. Loe MWC, Yeo KT. Early-life surface colonization with multi-drug resistant organisms in the neonatal intensive care unit. Int J Infect Dis, 2023, 136: 11-13.
9. Ramirez CB, Cantey JB. Antibiotic resistance in the neonatal intensive care unit. Neoreviews, 2019, 20(3): e135-e144.
10. Flannery DD, Chiotos K, Gerber JS, et al. Neonatal multidrug-resistant gram-negative infection: epidemiology, mechanisms of resistance, and management. Pediatr Res, 2022, 91(2): 380-391.
11. De Rose DU, Pugnaloni F, Martini L, et al. Staphylococcal infections and neonatal skin: data from literature and suggestions for the clinical management from four challenging patients. Antibiotics (Basel), 2023, 12(4): 632.
12. Rallis D, Giapros V, Serbis A, et al. Fighting antimicrobial resistance in neonatal intensive care units: rational use of antibiotics in neonatal sepsis. Antibiotics (Basel), 2023, 12(3): 508.
13. 刘敬, 冯星, 胡才宝, 等. 新生儿肺脏疾病超声诊断指南. 中国当代儿科杂志, 2019, 21(2): 105-113.
14. 马雪玲, 史源, 蔡金华, 等. 新生儿颅脑磁共振检查临床实践的专家共识. 中国当代儿科杂志, 2022, 24(1): 14-25.
15. 何云雁, 陈凤, 张钰, 等. C 反应蛋白指导下的新生儿疑诊早发型败血症抗生素治疗策略. 中国当代儿科杂志, 2020, 22(1): 12-16.
16. Brown JVE, Meader N, Cleminson J, et al. C-reactive protein for diagnosing late-onset infection in newborn infants. Cochrane Database Syst Rev, 2019, 1(1): CD012126.
17. Minotti C, Barbieri E, Giaquinto C, et al. Vancomycin use in children and neonates across three decades: a bibliometric analysis of the top-cited articles. Pathogens, 2021, 10(10): 1343.
18. Wang Z, Xia Z. What we can do? The risk factors for multi-drug resistant infection in pediatric intensive care unit (PICU): a case-control study. Ital J Pediatr, 2020, 46(1): 17.
19. 黄兰清, 陈清秀, 蔡榕, 等. 儿童重症监护室多重耐药菌感染情况及危险因素. 中华医院感染学杂志, 2020, 30(9): 1436-1440.
20. 蒲定红, 余漪漪, 孙慧. 儿童重症监护室住院患儿多重耐药菌感染的特点及危险因素. 贵州医科大学学报, 2024, 49(4): 589-595, 602.
21. 朱永冰, 付丽娜, 陈中举, 等. 新冠疫情前后 PICU 细菌变迁及耐药性变化研究. 华中科技大学学报(医学版), 2023, 52(2): 233-238.
22. Tamma PD, Aitken SL, Bonomo RA, et al. Infectious diseases society of america guidance on the treatment of extended-spectrum β-lactamase producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P. aeruginosa). Clin Infect Dis, 2021, 72(7): e169-e183.
23. Póvoa P, Coelho L, Almeida E, et al. C-reactive protein as a marker of infection in critically ill patients. Clin Microbiol Infect, 2005, 11(2): 101-108.
24. Golli AL, Cristea OM, Zlatian O, et al. Prevalence of multidrug-resistant pathogens causing bloodstream infections in an intensive care unit. Infect Drug Resist, 2022, 15: 5981-5992.
25. Al-Sunaidar KA, Aziz NA, Hassan Y, et al. Association of multidrug resistance bacteria and clinical outcomes of adult patients with sepsis in the intensive care unit. Trop Med Infect Dis, 2022, 7(11): 365.
26. Haddadin Y, Annamaraju P, Regunath H. Central line-associated blood stream infections. Treasure Island: StatPearls, 2022.
27. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis, 2009, 49(1): 1-45.
28. Inchingolo R, Pierandrei C, Montemurro G, et al. Antimicrobial resistance in common respiratory pathogens of chronic bronchiectasis patients: a literature review. Antibiotics (Basel), 2021, 10(3): 326.
29. Fan N, Hu Y, Shen H, et al. Compositional and drug-resistance profiling of pathogens in patients with severe acute pancreatitis: a retrospective study. BMC Gastroenterol, 2020, 20(1): 405.
30. Sartelli M, Tascini C, Coccolini F, et al. Management of intra-abdominal infections: recommendations by the Italian council for the optimization of antimicrobial use. World J Emerg Surg, 2024, 19(1): 23.
31. Hall CW, Mah TF. Molecular mechanisms of biofilm-based antibiotic resistance and tolerance in pathogenic bacteria. FEMS Microbiol Rev, 2017, 41(3): 276-301.
32. Vincent JL, Marshall JC, Namendys-Silva SA, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med, 2014, 2(5): 380-386.
33. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr, 2019, 38(1): 48-79.
34. Sung K, Park M, Kweon O, et al. Proteomic insights into dual-species biofilm formation of E. coli and E. faecalis on urinary catheters. Sci Rep, 2025, 15(1): 3739.
35. Ezzariga N, Zouhari O, Rhars A, et al. Biofilm and antibiotic resistance study of bacteria involved in nosocomial infections. Cureus, 2025, 17(2): e78673.
36. Rodríguez-Villodres Á, Martín-Gandul C, Peñalva G, et al. Prevalence and risk factors for multidrug-resistant organisms colonization in long-term care facilities around the world: a review. Antibiotics (Basel), 2021, 10(6): 680.
37. Wu C, Lu J, Ruan L, et al. Tracking epidemiological characteristics and risk factors of multi-drug resistant bacteria in intensive care units. Infect Drug Resist, 2023, 16: 1499-1509.
38. Hota B. Contamination, disinfection, and cross-colonization: are hospital surfaces reservoirs for nosocomial infection?. Clin Infect Dis, 2004, 39(8): 1182-1189.
39. Vincent JL, Rello J, Marshall J, et al. International study of the prevalence and outcomes of infection in intensive care units. JAMA, 2009, 302(21): 2323-2329.
40. Jensen JU, Hein L, Lundgren B, et al. Invasive candida infections and the harm from antibacterial drugs in critically ill patients: data from a randomized, controlled trial to determine the role of ciprofloxacin, piperacillin-tazobactam, meropenem, and cefuroxime. Crit Care Med, 2015, 43(3): 594-602.
41. Prechter F, Katzer K, Bauer M, et al. Sleeping with the enemy: clostridium difficile infection in the intensive care unit. Crit Care, 2017, 21(1): 260.
42. Armand-Lefèvre L, Angebault C, Barbier F, et al. Emergence of imipenem-resistant gram-negative bacilli in intestinal flora of intensive care patients. Antimicrob Agents Chemother, 2013, 57(3): 1488-1495.
43. Özger HS, Fakıoğlu DM, Erbay K, et al. Inapropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic policies in ICUs: a prospective observational study. BMC Infect Dis, 2020, 20(1): 289.
44. Macera M, Calò F, Onorato L, et al. Inappropriateness of antibiotic prescribing in medical, surgical and intensive care units: results of a multicentre observational study. Life (Basel), 2021, 11(6): 475.
45. Melnyk AH, Wong A, Kassen R. The fitness costs of antibiotic resistance mutations. Evol Appl, 2015, 8(3): 273-283.
46. 何礼贤. 限制抗菌药物使用对降低耐药率作用的争议: 解读与思考. 中华医学杂志, 2022, 102(20): 1487-1491.
47. 彭雅兰, 林吉, 黄文治, 等. 过氧化氢发生器对多重耐药菌消毒效果的 meta 分析. 华西医学, 2021, 36(3): 341-347.
48. Doll M, Morgan DJ, Anderson D, et al. Touchless technologies for decontamination in the hospital: a review of hydrogen peroxide and UV devices. Curr Infect Dis Rep, 2015, 17(9): 498.
49. Deshpande A, Dunn AN, Fox J, et al. Monitoring the effectiveness of daily cleaning practices in an intensive care unit (ICU) setting using an adenosine triphosphate (ATP) bioluminescence assay. Am J Infect Control, 2020, 48(7): 757-760.
50. 何莉, 吕宇, 徐丽萍, 等. 各种干预措施对基层综合医院多重耐药菌控制效果研究. 华西医学, 2017, 32(3): 329-333.
51. 钟晓, 肖丽华, 吴庆飞, 等. 比较三种检测方法在检测医院高频接触物体表面清洁消毒效果的作用和成本效果. 热带医学杂志, 2018, 18(1): 32-35.
52. Feng Y, Wei L, Zhu S, et al. Handwashing sinks as the source of transmission of ST16 carbapenem-resistant Klebsiella pneumoniae, an international high-risk clone, in an intensive care unit. J Hosp Infect, 2020, 104(4): 492-496.
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West China Medical Journal

Risk factors and prevention and control strategies for hospital-acquired multidrug-resistant bacterial infections in intensive care unit patients

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