The spread of multidrug-resistant organisms (MDRO) is associated with additional costs as well as higher morbidity and mortality rates. Risk factors related to the spread of MDRO can be classified into four categories: bacterial, host-related, organizational, and epidemiological. Faced with the severity of the MDRO predicament and its individual and collective consequences, many scientific societies have developed recommendations to help healthcare teams control the spread of MDROs. These international recommendations include a series of control measures based on surveillance cultures and the application of barrier measures, ranging from patients’ being isolated in single rooms, to the reinforcement of hand hygiene and implementation of additional contact precautions, to the cohorting of colonized patients in a dedicated unit with or without a dedicated staff. In addition, most policies include the application of an antimicrobial stewardship program. Applying international policies to control the spread of MDROs presents several challenges, particularly in low-to-middle-income countries (LMICs). Through a review of the literature, this work evaluates the real risks of dissemination linked to MDROs and proposes an alternative policy that caters to the means of LMICs. Indeed, sufficient evidence exists to support the theory that high compliance with hand hygiene and antimicrobial stewardship reduces the risk of MDRO transmission. LMICs would therefore be better off adopting such low-cost policies without necessarily having to implement costly isolation protocols or impose additional contact precautions.

Stenotrophomonas maltophilia, an environmental aerobic non-fermentative Gram-negative bacilli, has gained attention in many nosocomial outbreaks. COVID-19 patients in intensive care unit have extended hospital stay and are severely immunosuppressed. This study aimed to determine the prevalence and risk factors of S.maltophilia pneumonia in critical COVID-19 patients. A total of 123 COVID-19 patients in ICU admitted between March 2020 and March 2021 were identified from the authors’ institutional database and assessed for nosocomial pneumonia. Demographic data and factors predisposing to S. maltophilia pneumonia were collected and analyzed. The mean age was 66 ± 13 years and 74% were males. Median APACHE and SOFA scores were 13 (IQR = 8–19) and 4 (3–6), respectively. The Median NEWS2 score was 6 (Q1 = 5; Q3 = 8). The Median ICU stay was 12 (Q1 = 7; Q3 = 22) days. S. maltophilia was found in 16.3% of pneumonia patients, leading to a lengthier hospital stay (34 vs. 20 days; p < 0.001). Risk factors for S. maltophilia pneumonia included previous treatment with meropenem (p < 0.01), thrombopenia (p = 0.034), endotracheal intubation (p < 0.001), foley catheter (p = 0.009) and central venous catheter insertion (p = 0.016). S.maltophilia nosocomial pneumonia is frequent in critical COVID-19 patients. Many significant risk factors should be addressed to reduce its prevalence and negative impact on outcomes.

Emergence of difficult-to-treat-resistance (DTR) P. aeruginosa has significant implications for the selection of empirical therapies. This study aims to compare antimicrobial resistance of P. aeruginosa from ICU and non-ICU patients and to discuss empirical treatment options. Three-hundred-nine P. aeruginosa strains isolated from hospitalized patients in 2023 were included. Antimicrobial susceptibility results for six classes with potential activity against P. aeruginosa were collected. Resistance between strains isolated from ICU and non-ICU was compared. Among 309 strains, 30% were isolated from ICU patients, while 70% from non-ICU. Resistance to ciprofloxacin was significantly higher in non-ICU compared to ICU patients (64% vs. 15%, p-value = 0.0001). Resistance to piperacillin-tazobactam was higher in ICU compared to non-ICU patients (36% vs. 22%, p-value = 0.012). Prevalence of DTR P. aeruginosa was similar between the two groups (21% in ICU and 19% in non-ICU patients). Joint resistance to imipenem and ceftazidime was more prevalent in ICU patients (27% vs. 10%, p-value 0.0001). Additionally, carbapenemase-producing strains were more frequent in ICU patients (20% vs. 5%, p-value = 0.0001). Ceftolozane-tazobactam, whose effectiveness against DTR P. aeruginosa remains preserved, as empirical treatment, would improve its adequacy by 21% in ICU and 19% in non-ICU patients, compared to the currently recommended first-line treatments.