Evaluation of Antimicrobial Utilization and Inferred Bacterial Resistance in the ICU of the National Hospital of Itauguá, Paraguay

Abstract

Introduction: Antimicrobial resistance (AMR) is a global public health crisis, with intensive care units (ICUs) as hotspots for multidrug-resistant (MDR) pathogens. In Paraguay, the lack of local data on antimicrobial use and resistance profiles limits evidence-based therapeutic strategies. Objective: to determine antimicrobial usage patterns and their relationship with bacterial resistance in ICU patients at the National Hospital of Itauguá (HNI). Materials and Methods: Observational, descriptive, cross-sectional study. We analyzed 404 records of patients aged >18 years, admitted for >48 hours to HNI’s ICU between January and March 2025. Sociodemographic and clinical variables, antimicrobial prescriptions, microbiological isolates, and outcomes were evaluated. In the absence of susceptibility testing, resistance was inferred from the use of WHO “Reserve” antibiotics, indicative of resistance to first-line agents. Descriptive statistics were performed using EpiInfo 7.2. Results: Median age: 53 years; 61.42% male; overall mortality: 28.5%. Sepsis/septic shock was the main diagnosis (45.3%). WHO “Reserve” antibiotics, mainly linezolid (37.9%) and tigecycline (31.7%), dominated prescriptions, suggesting methicillin and carbapenem resistance. Most prevalent pathogens: coagulase-negative staphylococci (29.9%), K. pneumoniae (26.5%), A. baumannii (24.8%). A. baumannii infections were associated with 33% mortality vs. 13.5% and longer stays (27 vs. 12 days). Conclusion: HNI’s ICU faces a critical AMR crisis, with dependency on last-line antibiotics and severe clinical consequences. There is an urgent need for antimicrobial stewardship, microbiological surveillance, and strengthened infection control.