الفهرس 
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Abstract
The oncological patients are highly susceptible to infections, especially immun-ocompromised patients in ICUs. Antibiotic resistance rate varies by time, geo-graphical regions and patient characteristics.
In the presented study, we examined the ICUs epidemiology to identify bacterial strains that infect patients, the antimicrobial resistance rate, molecular epidemiology of β-lactamases and predictors of repeated infections, drug resistance in GNB.
Bacterial collection included clinical samples that taken from patients admitted to ICUs, samples sources were blood, urine, sputum, pus, mouth and nasal swabs.
Results obtained in this study can be summarized in:
A total number of 498 samples were collected; 241of total samples were positive cultures. The main source of bacterial strains was blood, followed by urine, sputum, mouth/ nasal swabs and pus, respectively. In our study, ICUs patients were highly infected with GNB (71.78%) than GPB (28.22%). K. pneumoniae (31.55%) was the most prevalent organism in ICUS patients, followed by E. coli (25%) and Staphylococcus spp. (22%) and small percentage of other bacterial strains. This study clearly showed the emergence of MDR-GNB.
The study showed the emergence of extremely high cefazolin, ampicillin, ampicillin/sulbactam, ceftriaxone, cefepime, trimethoprim/sulfamethoxazole, cefoxitin, levofloxacin and ciprofloxacin resistance among GNB. Also, showed the emergence of extremely high oxacillin, benzylpencillin, ampicillin, erythromycin and trimethoprim/sulfamethoxazole resistance among GPB.
The results demonstrated the prevalence of β-lactamases genes among GNB, SHV (57.8%) was the main type, followed by TEM (52%) and CTX-M-1 (46.8%) type. K. pneumoniae and E. coli were highly producing ESBLs enzymes. K. pneumoniae (31%) and E. coli (22.45%) were the two main bacteria with repeated infections. More frequent use of carbapenems was found in patients infected with K. pneumoniae. More frequent use of fluroquinolones and tetracycline were found in patients infected with E. coli. In multivariable analysis, only longer prior stay in ICUs was found as a risk factor associated with repeated infections, longer prior stay in ICUs and type of the malignant neoplasm were found as a risk factor associated with drug resistance in GNB. The spread of pathogenic bacteria, antimicrobial resistance and repeated infections in ICUs patients were alarming high.
A presence of infection control program should be follow up in ICUs for controlling infection and preventing the spread of antimicrobial resistance. These guidelines include prudent use of antibiotics and periodic preview of determining the bacterial patterns and antimicrobial resistance.