AGNBAerobic Gram-Negative Bacillus
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One hundred and forty (22%) patients had surveillance cultures positive for AGNB in their admission flora (Table 1).
Seventy-two patients (16 community, 56 hospital) carried AGNB resistant to third generation cephalosporins and 67 patients carried MRSA intrinsically resistant to third generation cephalosporins.
9%) patients with bacteria resistant to third generation cephalosporins (MRSA n=22, resistant AGNB n=27).
Thirty percent of the study population carried abnormal flora on arrival to ICU; 22 and 11% carried AGNB and MRSA, respectively.
Bacteria resistant to third generation cephalosporins used as the parenteral component of SDD, including MRSA and AGNB, were present in surveillance cultures to a higher extent (threefold) than in the diagnostic samples.
MRSA and AGNB carriers were significantly more common in the hospital group.
The immediate administration of broad-spectrum antimicrobials on admission has been shown to improve survival (21,22) and recent literature recommends a broad-spectrum antibiotic combination, to cover multi-resistant AGNB and MRSA in patients admitted from the hospital (23,24).
Abnormal carriers of AGNB and MRSA had overgrowth concentrations on ICU admission.
Our observation confirms the results of an American study in which 18% of patients carried resistant AGNB in their admission flora, while only 5% of patients had resistant AGNB in diagnostic cultures (18).
Previous antibiotic usage has been recognised to promote abnormal carriage with resistant AGNB and MRSA.