Epidemiological study of prevalence, determinants, and outcomes of infections in medical ICU at a tertiary care hospital in India

Abstract

Objectives:To determine the prevalence of infections, risk factors, and outcomes in a medical intensive care unit (ICU), we performed a hospital-based study.Materials and Methods:Consecutive patients were enrolled and details of risk factors and bacteriological data were obtained. Outcomes were death/transfer to palliative care or recovery. Statistical analyses were performed.Results:Four hundred and eighty-seven patients were admitted during the study period (age 55.6 ± 19 yr, men 68%). Diseases responsible were respiratory (37%), gastrointestinal/liver (22%), neurological (20%), renal (8%), and trauma (6%) related. Majority of admissions were direct (45%) or transfers from other hospitals (41%). Most important comorbidities were hypertension (41%), diabetes (31%), and chronic obstructive pulmonary disease (15%). Median APACHE-2 score was 13.0 (IQR 1–25). Antibiotics were administered in 98%. Bacteriological cultures were positive in 28% (n = 623). Respiratory infections were the most common (45.5%) followed by blood (23.3%) and urinary (16.1%). Gram-negative bacteria were common–Acinetobacter baumannii (20.9%), Klebsiella pneumoniae (19.7%), Escherichia coli (18.3%), and Pseudomonas aeruginosa (14.0%). There a high prevalence of resistance to common antibiotics. Patients with positive cultures were older, transferees (46 vs 37%, P = 0.07), with respiratory disease (48 vs. 33%, P = 0.003), with more than two comorbidities (33 vs 21%, P = 0.009), and higher APACHE-2 score (17.7 ± 8 vs. 13.3 ± 8, P = 0.07). Three hundred and fifty-two (72.3%) recovered, 68 (13.9%) died, and 67 (13.8%) were transferred to palliative care. Survival was associated with younger age, lower APACHE-2 score, negative cultures, and shorter duration in ICU (P < 0.05). Mortality was greater in patients with Acinetobacter (OR 2.36, 1.17–4.73), Klebsiella (OR 2.81, 1.33–5.92), Pseudomonas (OR 8.03, 2.83–22.76), or Enterobacter (OR 6.73, 1.29–35.12) infection.Conclusions:There is high prevalence of infections in patients in a medical ICU in India. Gram-negative bacteria are the most prevalent and resistance to antibiotics is high. Risk factors are age, hospital transfers, APACHE-2 score, and multiple comorbidities.

Antimicrobial resistance of acinetobacter baumannii infection of lower respiratory tract and mortality – A cross-sectional study from a tertiary care teaching hospital in Kerala

“…It has uncanny ability to survive for prolonged periods in hospital environment [16][17][18]. The organism commonly targets the most vulnerable hospitalized patients, those who are critically ill with breaches in skin integrity and airway protection [15]. In our study, it was seen that 90% of infections occurred among the patients in ICUs, who were also on mechanical ventilation.…”

“…The study was focused on nosocomial lower respiratory infections due to Acinetobacter baumannii. Among the nosocomial infections, pneumonia is the most common and the organisms are most commonly are gram negative, particularly Acinetobacter baumannii in ICUs [15]. All the Acinetobacter baumannii infections were nosocomial.…”

Study of Resistance for Recently Marketed Carbapenem Drug Among Hospitalised Patients in Sana'a, Yemen

“…Shivesh P et al, 9 reported 15% and Shashikala et al, 10 found 10.9% carbapenem resistance in their respective studies. In a study by Sachin Kumar Wankhede et al, 11 found 19.40% carbapenem resistant. Resistance to carbapenem in this study is low compared to studies from India.…”

Infectious pneumonia in the immunocompetent host: What the radiologist should know

“…Recent data from the Indian intensive care unit (ICU) setting shows that most of the pathogens are resistant to common antibiotics. [1] Empirical broad spectrum antimicrobial therapy is one of the causes responsible for this. Unusual infections are encountered more frequently now because of increased survival in acquired immunodeficiency syndrome (AIDS) patients, incidence of organ transplants, and emergence of newer viruses with atypical imaging features.…”