Clinical profile, bacterial profile and outcomes in an intensive care unit of a tertiary care hospital in south India: one year study

Abstract

Prevalence of ICU infections varies between 45% to 58% 10 and incidence rates between 30 to 35%. 11,12 Factors associated with increased risk of infections in ICU are ABSTRACT Background: Infections still remain as one of the major cause of mortality in low and lower-middle-income countries as reported by Global Burden of Diseases study. Intensive care units (ICU) are a major source of infections in tertiary care hospitals. Widespread multi-drug resistant gram positive and gram negative bacterial isolates are also associated with infections in ICU. A hospital based epidemiological study was to determine the risk factors; bacterial isolates, antibiotic sensitivity and outcomes in ICU patients. Methods: This prospective study was done at Narayana Medical College and Hospital for 12 months from 1 st February 2015 to 31 st January 2016. All the risk factors were noted. Patient's outcome noted as death, recovery and transfer to palliative care. Data entry and analysis performed in Microsoft excel, p valve < 0.001 was considered significant. Results: Three hundred and thirty patients were included in the study (age: 56.16±15 years, 57.6% males). 159 (48.2%) were direct admissions, 103 (31.2%) were transfers from other hospitals. Major cause of admission was neural (29.1%) followed by cardiovascular (21.8%). HTN (52.4%) was major co-morbidity followed by type-2 DM (47.3%). 51.9% culture positivity (n = 539) was observed with sputum 83.6% and blood 24.2%. Gram-negative pathogens were predominant which includes Acinetobacter baumanii (13.8%), Escherichia coli (20%), Klebsiella pneumoniae (14.3%), Pseudomonas aeruginosa (9%), Enterobacter aerogenes (5.1%). Candida Sp and MRSA, VRE were isolated. In the study 255(77.3%) recovered, 38(11.5%) progressed to death and 37(11.2%) transferred to palliative care. Higher mortality was noticed with Acinetobacter baumani (81.6%). Conclusions: High prevalence of gram-negative bacterial infections and multi-drug resistant isolates was noted in Indian ICUs. Sarvepalli AK et al. Int J Adv Med. 2017 Feb;4(1):156-161 International Journal of Advances in Medicine | January-February 2017 | Vol 4 | Issue 1 Page 157 intrinsic risk factors associated with the patient, invasive medical devices, overcrowding and animate objects which act as reservoirs for bacterial isolates. Higher incidence and prevalence of infections in ICU are associated with higher age, higher APACHE-2 score (Acute physiology and chronic health evaluation) and associated co morbid conditions. Widespread multi-drug resistant gram positive and gram negative bacterial isolates are also associated with infections in ICU. Reports on the emergence of metallo β-lactamase (MBL) and carbapenemase-producing gram negative bacterial isolates, methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant enterococci (VRE) are posing a serious threat in outcomes of patients in ICU. KeywordsThe present study was sought to determine the prevalence of infections, clinical risk factors, bacterial isolates and antibiotic profil...

Trimethoprim - Sulfamethoxazole in Combination With Meropenem Orpolymyxin is Effective in Management of Acinetobacter Baumannii Associated Pneumonia and Urinary Tract Infection

“…Gram nega ve infec on is more common in developing country [10] ICU and incidence ranges from 47 to 84%. [10] Acinetobacter baumanniiis a MDR bacteria and incidence ranges from 13 to 41% [11][12][13] and mortality is very high up [11][12][13] to 81%.…”