Antimicrobial Resistance Profile in ICUs of Tertiary Care Hospital—A Worrisome State of Affairs

Abstract

Background and objectives: Nosocomial infections/Hospitalacquired infections (HAI) constitute an important problem worldwide accounting for high morbidity and mortality as well as longer hospital cost and stay. An intensive care unit (ICU) is often the epicenter of infection, due to its extremely vulnerable population. Consequently, ICUs have highest occurrence rates of nosocomial infections causing an enormous impact on health and often survival. This study was therefore aimed to know the prevalence and antibiotic susceptibility profile of various organisms causing HAI in ICUs of a Tertiary Care Hospital and Medical College. Materials and methods:A total of 847 consecutive samples mostly respiratory secretions, blood, and urine were collected from patients admitted in 6 ICUs of a tertiary care hospital and medical college from January 2017 to December 2017 and processed as per Clinical and Laboratory Standards Institute (CLSI) guidelines in the Microbiology department. Final identification and antimicrobial susceptibility testing of isolates were done by the automated Vitek 2 system.Results: Among the 847 samples processed 513 (60.5%) were positive for growth. Gram-negative organisms 366/513 (71.34%) were more commonly isolated than 147/513 (28.65%) Gram-positive organisms. Multidrug-resistant (MDR), Klebsiellapneumoniae, Acinetobacterbaumannii complex and Pseudomonasaeruginosa along with Extended-spectrum betalactamases (ESBL) producing Escherichia coli among Gramnegative organisms and methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE) among Gram-positive were the most conspicuous findings. Conclusion:Our results showed higher resistance among all microorganisms in the ICUs compared to the rest of the hospital, the fact that highlights that ICUs should act as a critical point in the control of nosocomial infections.

MDROs—The New Age Challenge

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In continuation with our article on "Antimicrobial resistance profile in ICUs of tertiary care hospital-a worrisome state of affairs," I want to stress on alarming rise of multidrug-resistant organisms (MDROs) in our hospital. 1 This study shows that 80% Enterobacteriaceae isolated from ICUs are resistant to the third-generation cephalosporins and more than 90% Staphylococcus aureus isolated are MRSA, i.e., methicillin-resistant S. aureus. A bulk of hospital-acquired infections are caused by Acinetobacter baumannii and Pseudomonas aeruginosa showing 80% of resistance to carbapenems which is much more than seen in other tertiary care hospitals.

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