Background and objective: Antibiotic resistance has increased as a major problem in hospitals in recent years. Respiratory tract infection in intensive care unit (ICU) patients has also been raised as an important issue among intubated patients, which leads to high morbidity and mortality. The present study aimed to investigate the trend of antibiotic resistance of organisms isolated from endotracheal tube secretions of patients hospitalized in Shahid Beheshti Hospital, Kashan, over a five-year period, in order to provide valuable information to policymakers.
Methods: In this cross-sectional study, the records of 925 intubated patients with positive endotracheal tube cultures were reviewed in Shahid Beheshti Hospital, Kashan, during the period 2018 to 2022. Data extracted from the records included demographic variables (age, gender, and reason for hospitalization), type of bacteria isolated from the endotracheal tube, antibiogram test results, length of hospital stay, and outcome (discharge or death). For isolation and antibiogram testing of endotracheal tube samples transferred to the laboratory, the hospital laboratory first cultured the endotracheal tube samples in blood agar and MacConkey agar, and after 24 hours of incubation, the grown bacteria were identified. The disk diffusion method was used to determine antibiotic resistance based on the guidelines of the Clinical and Laboratory Standards Institute (CLSI). The collected data were analyzed using SPSS version 26 software using descriptive statistics (frequency distribution, mean, and standard deviation) and inferential statistics (Chi-square test and independent t-test to examine the relationship between multidrug resistance and clinical characteristics). Also, the trend of antibiotic resistance pattern over a five-year period was examined using the join point regression test by calculating the average annual percentage change index (AAPC) and through Joinpoint Trend Analysis software version 5.3.0.






Results: A total of 925 bacterial pathogens isolated from endotracheal tube cultures were examined over a five-year period, of which 57.8% were male and 42.2% were female. The findings showed that the most common bacteria isolated from endotracheal tube cultures were Acinetobacter species (52.5%) and Klebsiella species (29.4%). The antibiotic resistance pattern among the common bacteria isolated showed that Acinetobacter and Klebsiella species were most resistant to the antibiotic ceftazidime (98.5% and 93.6%, respectively). However, based on AAPC values, only the trend of resistance to the antibiotic cephalosporin increased significantly by 4.63% per year. In addition, in terms of the trend of changes in multidrug resistance (MDR) and based on AAPC values, the trend of multidrug resistance in Klebsiella species increased significantly by 7.78% per year.
Conclusion: Given that there was an unacceptably low antibiotic susceptibility among the isolates. However, overall, the trend of antimicrobial resistance among the isolates was increasing. Given the significant increase in antibiotic resistance, especially in Acinetobacter and Klebsiella, implementation of antibiotic management strategies, continuous monitoring of resistance patterns, and control measures are essential to reduce the transmission of MDR bacteria.