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Journal of Clinical Care and Skills

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Volume 6, Issue 3 (2025)                   J Clinic Care Skill 2025, 6(3): 147-154 | Back to browse issues page
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Descriptive Study |
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‎ 10.58209/jccs.6.3.147

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Received: 2025/05/23 | Accepted: 2025/07/1 | Published: 2025/07/5
How to cite this article
Nazar E, Abdollahi A, Afarinesh Khaki P, Norouzi Shadehi M, Beighmohammadi M, Nateghi S, et al . Antibiotic Susceptibility of Body Fluids and Urine Cultures from Intensive Care Unit Patients in a Tertiary Care Center in Iran. J Clinic Care Skill 2025; 6 (3) :147-154
URL: http://jccs.yums.ac.ir/article-1-424-en.html
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Antibiotic Susceptibility of Body Fluids and Urine Cultures from Intensive Care Unit Patients in a Tertiary Care Center in Iran
Authors E. Nazar1 , A. Abdollahi2 , P. Afarinesh Khaki3 , M. Norouzi Shadehi3 , M.T. Beighmohammadi4 , S. Nateghi5 , Z. Panahi6 , A. Nozheh *1
1- “Department of Pathology, Faculty of Medicine” and “Sina Hospital”, Tehran University of Medical Sciences, Tehran, Iran
2- Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
3- Central laboratory of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
4- Department of Intensive Care Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
5- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
6- Department of Obstetrics and Gynecology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
* Corresponding Author Address: Faculty of Medicine, Tehran University of Medical Sciences, PourSina Street, Tehran, Iran. Postal Code: 14197333141 (a-nozheh@razi.tums.ac.ir)
Abstract   (290 Views)

Aims: Rising antibiotic resistance among prevalent pathogens poses a critical challenge, especially in intensive care unit patients. This study aimed to evaluate antibiotic susceptibility and resistance patterns in body fluid and urine samples from intensive care unit patients at a tertiary care center in Tehran, Iran.
Instrument & Methods: This cross-sectional study analyzed cultures from body fluids and urine samples collected from intensive care unit patients at Imam Khomeini Hospital between 2019 and 2022. Cultures were processed according to standard protocols and interpreted based on growth inhibition zones to classify bacterial isolates as sensitive, intermediate, or resistant. Data analysis was performed using STATA 17.
Findings: A total of 4,232 body fluid and 4,062 urine samples were examined; 2,400 body fluid and 2,824 urine cultures were negative. The most common bacteria in urine were Klebsiella pneumoniae (16.7%), Escherichia coli (15.43%), and Pseudomonas aeruginosa (6.08%), while body fluids predominantly grew Klebsiella pneumoniae (37.19%), Acinetobacter baumannii (25.52%), and Pseudomonas aeruginosa (8%). Klebsiella pneumoniae showed the highest sensitivity to Gentamicin (12.37% in body fluids, 17.93% in urine) and imipenem (9.72% in body fluids, 14.67% in urine). Resistance was notably high against ampicillin-sulbactam (over 90%), ciprofloxacin (85-89%), and cotrimoxazole or nitrofurantoin (84-88%), depending on the sample type.
Conclusion: Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus have a high resistance against many antimicrobial agents.
 

Keywords:
Antibiotic Resistance [MeSH], Urine [MeSH], Antibiogram [MeSH], Intensive Care Unit [MeSH], Iran [MeSH]
References
1. Van Duijn PJ, Verbrugghe W, Jorens PG, Spöhr F, Schedler D, Deja M, et al. The effects of antibiotic cycling and mixing on acquisition of antibiotic resistant bacteria in the ICU: A post-hoc individual patient analysis of a prospective cluster-randomized crossover study. PLoS One. 2022;17(5):e0265720. [Link] [DOI:10.1371/journal.pone.0265720]
2. Serra-Burriel M, Campillo-Artero C, Agodi A, Barchitta M, López-Casasnovas G. Association between antibiotic resistance in intensive care unit (ICU)-acquired infections and excess resource utilization: Evidence from Spain, Italy, and Portugal. Infect Control Hosp Epidemiol. 2022;43(10):1360-7. [Link] [DOI:10.1017/ice.2021.429]
3. Cornes M, Ibarz M, Ivanov H, Grankvist K. Blood sampling guidelines with focus on patient safety and identification-a review. Diagnosis. 2019;6(1):33-7. [Link] [DOI:10.1515/dx-2018-0042]
4. De Waele JJ, Akova M, Antonelli M, Canton R, Carlet J, De Backer D, et al. Antimicrobial resistance and antibiotic stewardship programs in the ICU: Insistence and persistence in the fight against resistance. A position statement from ESICM/ESCMID/WAAAR round table on multi-drug resistance. Intensive Care Med. 2018;44(2):189-96. [Link] [DOI:10.1007/s00134-017-5036-1]
5. Pachori P, Gothalwal R, Gandhi P. Emergence of antibiotic resistance Pseudomonas aeruginosa in intensive care unit; A critical review. Genes Dis. 2019;6(2):109-19. [Link] [DOI:10.1016/j.gendis.2019.04.001]
6. Weber DJ, Raasch R, Rutala WA. Nosocomial infections in the ICU: The growing importance of antibiotic-resistant pathogens. Chest. 1999;115(3):34S-41S. [Link] [DOI:10.1378/chest.115.suppl_1.34S]
7. Moradi Tabriz H, Abdollahi A, Mahfoozi S. Frequency of pathogens and antimicrobial susceptibility of bacteria isolated from bloodstream infections. Iran J Pathol. 2010;5(3):143-9. [Link]
8. Hanberger H, Diekema D, Fluit A, Jones R, Struelens M, Spencer R, et al. Surveillance of antibiotic resistance in European ICUs. J Hosp Infect. 2001;48(3):161-76. [Link] [DOI:10.1053/jhin.2001.0987]
9. Oostdijk EA, Kesecioglu J, Schultz MJ, Visser CE, De Jonge E, Van Essen EH, et al. Effects of decontamination of the oropharynx and intestinal tract on antibiotic resistance in ICUs: A randomized clinical trial. JAMA. 2014;312(14):1429-37. [Link] [DOI:10.1001/jama.2014.7247]
10. Nerurkar A, Solanky P, Naik SS. Bacterial pathogens in urinary tract infection and antibiotic susceptibility pattern. J Pharm Biomed Sci. 2012;21(21). [Link]
11. Shrestha S, Shrestha N, Singh SD, Shrestha R, Kayestha S, Shrestha M, et al. Bacterial isolates and its antibiotic susceptibility pattern in NICU. Kathmandu Univ Med J. 2013;11(41):66-70. [Link] [DOI:10.3126/kumj.v11i1.11030]
12. Ochoa Sangrador C, Brezmes Valdivieso MF; Grupo Investigador del Proyecto. Sample collection methods for urine culture and analysis. An Pediatr. 2007;67(5):442-9. [Spanish] [Link] [DOI:10.1157/13111597]
13. Thomas V, Clark J, Doré J. Fecal microbiota analysis: An overview of sample collection methods and sequencing strategies. Future Microbiol. 2015;10(9):1485-504. [Link] [DOI:10.2217/fmb.15.87]
14. Nozarian Z, Abdollahi A. Microbial etiology and antimicrobial susceptibility of bactria implicated in urinary tract infection in Tehran, Iran. Iran J Pathol. 2015;10(1):54-60. [Link]
15. Plantinga NL, Wittekamp BH, Van Duijn PJ, Bonten MJ. Fighting antibiotic resistance in the intensive care unit using antibiotics. Future Microbiol. 2015;10(3):391-406. [Link] [DOI:10.2217/fmb.14.146]
16. Barnsteiner S, Baty F, Albrich WC, Babouee Flury B, Gasser M, Plüss-Suard C, et al. Antimicrobial resistance and antibiotic consumption in intensive care units, Switzerland, 2009 to 2018. Euro Surveill. 2021;26(46):2001537. [Link] [DOI:10.2807/1560-7917.ES.2021.26.46.2001537]
17. Kollef MH, Fraser VJ. Antibiotic resistance in the intensive care unit. Ann Intern Med. 2001;134(4):298-314. [Link] [DOI:10.7326/0003-4819-134-4-200102200-00014]
18. Lee WC, Ho MC, Leu SW, Chang CC, Lin CK, Lin CM, et al. The impacts of bacterial co-infections and secondary bacterial infections on patients with severe influenza pneumonitis admitted to the intensive care units. J Crit Care. 2022;72:154164. [Link] [DOI:10.1016/j.jcrc.2022.154164]
19. Deege MP, Paterson DL. Reducing the development of antibiotic resistance in critical care units. Curr Pharm Biotechnol. 2011;12(12):2062-9. [Link] [DOI:10.2174/138920111798808301]
20. Lepape A, Jean A, De Waele J, Friggeri A, Savey A, Vanhems P, et al. European intensive care physicians' experience of infections due to antibiotic-resistant bacteria. Antimicrob Resist Infect Control. 2020;9(1):1. [Link] [DOI:10.1186/s13756-019-0662-8]
21. Saharman YR, Karuniawati A, Severin JA, Verbrugh HA. Infections and antimicrobial resistance in intensive care units in lower-middle income countries: A scoping review. Antimicrob Resist Infect Control. 2021;10(1):22. [Link] [DOI:10.1186/s13756-020-00871-x]
22. Khoshbakht R, Kabiri M, Neshani A, Khaksari MN, Sadrzadeh SM, Mousavi SM, et al. Assessment of antibiotic resistance changes during the Covid-19 pandemic in northeast of Iran during 2020-2022: An epidemiological study. Antimicrob Resist Infect Control. 2022;11(1):121. [Link] [DOI:10.1186/s13756-022-01159-y]
23. Raoofi R, Namavari N, Rahmanian V, Dousthaghi MH. Evaluation of antibiotics resistance in Southern Iran in light of COVID-19 pandemic: A retrospective observational study. Health Sci Rep. 2023;6(3):e1153. [Link] [DOI:10.1002/hsr2.1153]
24. Mehtarpour M, Takian A, Eshrati B, Jaafaripooyan E. Control of antimicrobial resistance in Iran: The role of international factors. BMC Public Health. 2020;20(1):873. [Link] [DOI:10.1186/s12889-020-09006-8]
25. Moradi J, Hashemi FB, Bahador A. Antibiotic resistance of Acinetobacter baumannii in Iran: A systemic review of the published literature. Osong Public Health Res Perspect. 2015;6(2):79-86. [Link] [DOI:10.1016/j.phrp.2014.12.006]
26. Heidary M, Nasiri MJ, Dabiri H, Tarashi S. Prevalence of drug-resistant klebsiella pneumoniae in Iran: A review article. Iran J Public Health. 2018;47(3):317-26. [Link]
27. Shoaee S, Rezaie F, Payab M, Bakhtiari F, Heydari MH. Experiences from the management of COVID-19 pandemic in a nursing home in Iran (March-April, 2020). J Diabetes Metab Disord. 2022;21(1):1195-9. [Link] [DOI:10.1007/s40200-022-01005-3]
28. Sofi-Mahmudi A, Masinaei M, Shamsoddin E, Tovani-Palone MR, Heydari MH, Shoaee S, et al. Global, regional, and national burden and quality of care index (QCI) of lip and oral cavity cancer: A systematic analysis of the global burden of disease study 1990-2017. BMC Oral Health. 2021;21(1):558. [Link] [DOI:10.1186/s12903-021-01918-0]
29. Shoaee S, Saeedi Moghaddam S, Masinaei M, Sofi-Mahmudi A, Hessari H, Heydari MH, et al. Trends in dental caries of deciduous teeth in Iran: A systematic analysis of the national and sub-national data from 1990 to 2017. BMC Oral Health. 2022;22(1):634. [Link] [DOI:10.1186/s12903-022-02634-z]
30. Mortazavi H, Sadeghian A, Hazrati P, Heydari MH, Madihi S. Oral hemorrhagic blister and its possible related factors: Analyzes of reported cases in the literature. J Oral Maxillofac Surg Med Pathol. 2023;35(4):358-67. [Link] [DOI:10.1016/j.ajoms.2022.12.009]
31. Alizade H. Escherichia coli in Iran: An overview of antibiotic resistance: A review article. Iran J Public Health. 2018;47(1):1-12. [Link]
32. Sharahi JY, Hashemi A, Ardebili A, Davoudabadi S. Molecular characteristics of antibiotic-resistant Escherichia coli and Klebsiella pneumoniae strains isolated from hospitalized patients in Tehran, Iran. Ann Clin Microbiol Antimicrob. 2021;20(1):32. [Link] [DOI:10.1186/s12941-021-00437-8]
33. Karimi E, Ghalibafan F, Esfandani A, Manoochehri Arash N, Mohammadi S, Khaledi A, et al. Antibiotic resistance pattern in pseudomonas aeruginosa isolated from clinical samples other than burn samples in Iran. Avicenna J Med Biotechnol. 2021;13(1):35-41. [Link] [DOI:10.18502/ajmb.v13i1.4575]
34. Vaez H, Salehi-Abargouei A, Ghalehnoo ZR, Khademi F. Multidrug resistant pseudomonas aeruginosa in Iran: A systematic review and metaanalysis. J Glob Infect Dis. 2018;10(4):212-7. [Link] [DOI:10.4103/jgid.jgid_113_17]