**5. Data of the ICU of the hospital of Sagunto**

Our unit starts the data collection in the ENVIN project the same year of its beginning (1994). We started the RZ project in April 2014, and until now (January 2018) have followed the guidelines of the RZ project in the prevention and management of patients with MRB. We reported 195 isolates in 179 patients for 46 months, with 1966 admissions and a rate of 9.1 patients with MRB/100 admissions (**Figure 13**).

In our unit, a high prevalence of *A. baumannii* was initially observed, without a clear seasonal profile. Over time, there is a decrease in *A. baumannii* and an increase in the ESBL carrier

**Figure 13.** Occurrence of MRB in our ICU Fromm the beginning of RZ project until February 2018. Acinetobacter supposes globally a 25% of isolates, with a rate of 50% of ESBL producer germs.

**Figure 12.** Heterogeneity of MRB isolates, counting colonizations and infections, during the period of RZ study. In most autonomous communities, the most frequent type of MRB is ESBL producing GNB. The presence of *A. baumannii* has become much less frequent, except in Extremadura and Asturias. In the Canary Islands, there are 0 VRE isolates; in Extremadura, there are zero isolates of VRE, one isolation of carbapenemase producing germ and three isolates of *P. aeruginosa*; there are few isolates of *A. baumannii* in Aragón [9], Canary Islands [8], Galicia [3] and Navarra [5]; and finally

there is no isolation (0) of *A. baumannii* in Euskadi.

54 Current Topics in Intensive Care Medicine

**Figure 14.** Accumulated frequency of colonized and infected patients by *A. baumannii* and ESBL producer germs.

**Figure 15.** Accumulated frequency of colonized and infected patients by the most frequently isolated germs in the ICU of the hospital of Sagunto.

bacteria, and a slowly increasing incidence of MRSA and *P. aeruginosa* (**Figure 13**). Assessing the cumulative incidence, there is a catch-up of the ESBL + germs to the initially predominant Acinetobacter at the end of 2015–beginning of 2016 (**Figure 14**); if we separate the ESBL + germs, the highest cumulative frequency of E coli than of *A. baumannii* is observed at the end of 2016. In the last months also, the frequency of occurrence of *K. pneumoniae* is higher than

**Figure 17.** MRB isolated at admission and during their stay, such as colonization or infection, at the local, regional and

Current Status of Colonization and Infection by Multiresistant Bacteria in the Spanish Intensive…

http://dx.doi.org/10.5772/intechopen.78236

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During the RZ project, in our unit, 80 MRB were detected on admission and 26 during stay; this implies a global estimate, during the entire project period, of 6.29 patients with BMR at admission for every 100 admitted patients, and 2.04 patients with BMR during their stay in ICU per 100 patients admitted and 5.72 patients for 1000 stays. The income indicator is significantly higher than that of the Valencian Community (2.22%) and the national one (2.62%); and the indicators during their income are only slightly larger than the regional (1.87 and 4.28‰) and national (1.82 and 3.36‰) estimates (**Figure 16**). There have only been three nosocomial infections for BMR acquired in ICU during this RZ period, 1 for Pa and 2 for Ab, with a BMR infection rate acquired in ICU lower (0.24 per 100 patients admitted to ICU) than the regional

The profile of germs is different: predominance in our unit of germs producing ESBL + (42.8%) and *A. baumannii* (35.3%), with a lower presence of *P. aeruginosa* (10.9%) and MRSA (10.1%). %); while at the regional and national level, the most common germs in decreasing order are Enterobacteria ESBL + (42.6% regional and 42% national), MRSA (21.5 and 21.2%), *P. aeruginosa* (16.7 and 16.8%), *A. baumannii* (10.5 and 9.2%) and GNB producers of carbapenemases (8.3

that of *A. baumannii* (**Figure 15**).

national levels.

(0.60%) and the national rates (0.79%).

and 9.1%) (**Figure 17**).


**Figure 16.** Indicators of the RZ project at the local (hospital of Sagunto), regional (Valencian community) and national (Spain) levels.


bacteria, and a slowly increasing incidence of MRSA and *P. aeruginosa* (**Figure 13**). Assessing the cumulative incidence, there is a catch-up of the ESBL + germs to the initially predominant Acinetobacter at the end of 2015–beginning of 2016 (**Figure 14**); if we separate the ESBL + germs, the highest cumulative frequency of E coli than of *A. baumannii* is observed at the end of 2016. In the last months also, the frequency of occurrence of *K. pneumoniae* is higher than that of *A. baumannii* (**Figure 15**).

During the RZ project, in our unit, 80 MRB were detected on admission and 26 during stay; this implies a global estimate, during the entire project period, of 6.29 patients with BMR at admission for every 100 admitted patients, and 2.04 patients with BMR during their stay in ICU per 100 patients admitted and 5.72 patients for 1000 stays. The income indicator is significantly higher than that of the Valencian Community (2.22%) and the national one (2.62%); and the indicators during their income are only slightly larger than the regional (1.87 and 4.28‰) and national (1.82 and 3.36‰) estimates (**Figure 16**). There have only been three nosocomial infections for BMR acquired in ICU during this RZ period, 1 for Pa and 2 for Ab, with a BMR infection rate acquired in ICU lower (0.24 per 100 patients admitted to ICU) than the regional (0.60%) and the national rates (0.79%).

The profile of germs is different: predominance in our unit of germs producing ESBL + (42.8%) and *A. baumannii* (35.3%), with a lower presence of *P. aeruginosa* (10.9%) and MRSA (10.1%). %); while at the regional and national level, the most common germs in decreasing order are Enterobacteria ESBL + (42.6% regional and 42% national), MRSA (21.5 and 21.2%), *P. aeruginosa* (16.7 and 16.8%), *A. baumannii* (10.5 and 9.2%) and GNB producers of carbapenemases (8.3 and 9.1%) (**Figure 17**).

**Figure 16.** Indicators of the RZ project at the local (hospital of Sagunto), regional (Valencian community) and national

**Figure 15.** Accumulated frequency of colonized and infected patients by the most frequently isolated germs in the ICU

**Figure 14.** Accumulated frequency of colonized and infected patients by *A. baumannii* and ESBL producer germs.

(Spain) levels.

of the hospital of Sagunto.

56 Current Topics in Intensive Care Medicine
