Background Based on the analysis of infections and antibiotic usage in the years 2013 and 2014, an evidence-based antibiotic protocol was developed and implemented in our cardiac surgical intensive care unit (CSICU). This study intends to study the impact of this new protocol on the sensitivity profiles of common gram-negative bacteria in our CSICU. Methods The medical records of patients who underwent cardiac surgery at our center, between January 2017 and December 2018, were reviewed and the incidence of different hospital-acquired bacteria and their antibiotic sensitivity profiles were recorded. The antibiotic-sensitivity profiles of common gram-negative bacteria, for the years 2017 and 2018, were compared with the published data of 2013 and 2014 from our department. Results There was a significant decrease in the incidence of Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa resistant to carbapenems during 2017 and 2018. The incidence of colistin-resistant A. baumannii and P. aeruginosa also decreased significantly in 2017 and 2018. A significant increase in the proportion of amikacin resistant A. baumannii and E. coli and A. baumannii resistant to B lactam/B lactamase inhibitors also occurred. Conclusion Antibiotic stewardship can reverse the antibiotic resistance of common gram-negative bacteria in the ICU.

Objectives To describe the outcomes of postoperative tracheostomy and determine the predictors of survival. Design Prospective, observational study. Setting Cardiac surgical intensive care unit of a tertiary care hospital. Participants All pediatric patients below 10 years of age who underwent tracheostomy after cardiac surgery from January 2019 to December 2019. Different variables were compared between survivors and nonsurvivors. Intervention Tracheostomy. Results Among 1084 pediatric patients who underwent cardiac surgery during the study period, 41 (3.7%) received tracheostomy. Survival rate was 71%.Earlier, sternal closure (SC) (p = 0.04), acute kidney injury (AKI) (p = 0.001), serum C-reactive protein (CRP) (p = 0.007), duration of total parenteral nutrition (TPN) (p = 0.005) and days of feed interruption (FI) (p = 0.02), activated partial thromboplastin time (aPTT) before tracheostomy (p = 0.006), and bleeding from tracheostomy site (p = 0.02) were significantly low in the survivor group.Among the peritracheostomy variables taken at different time points, the levels of pH on tracheostomy day 1 (p = 0.03), serum lactate on tracheostomy day 2 (p = 0.01) and day 3 (p = 0.01), and random blood sugar (RBS) on tracheostomy day 3 (p = 0.04) were significantly lower in the survivor group.The arterial oxygen saturation (SaO2) on tracheostomy day 1 (p = 0.04) and the platelet count before tracheostomy (p = 0.02) were significantly higher in the survivor group. Conclusions Our study demonstrated a survival of 71% among the study cohort. Lesser duration of open sternum, lower incidence of AKI, less number of days on TPN and FI, lower posttracheostomy aPTT, bleeding, RBS, lactate, and higher pretracheostomy platelet count and posttracheostomy SaO2 were found to be the predictors of survival.