Intensive care unit bugs in India: How do they differ from the Western world?

Chaudhry, Dhruva; Prajapat, Brijesh

doi:10.4103/2320-8775.196645

Cited by 34 publications

(29 citation statements)

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“…As a disastrous effect of infection, antimicrobial resistance is an increasing concern in ICUs worldwide [ 3 ]. The global scenario shows that gram-positive infections are common in the developed countries ICUs [ 4 ]. However, multidrug-resistant gram-negative bacteria (MDR-GNB) infections dominate in the Asia-Pacific region [ 4 , 5 ] including Nepal [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…The global scenario shows that gram-positive infections are common in the developed countries ICUs [ 4 ]. However, multidrug-resistant gram-negative bacteria (MDR-GNB) infections dominate in the Asia-Pacific region [ 4 , 5 ] including Nepal [ 6 , 7 ]. Among MDR-GNB, extended-spectrum beta-lactamases (ESBL) organisms, carbapenemase producing enterobacteriaceae, carbapenem-resistant Acinetobacter species , multidrug-resistant Pseudomonas aeruginosa are the major culprits.…”

Section: Introductionmentioning

confidence: 99%

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Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal- a prospective cohort study

Siwakoti

Subedi

Sharma

et al. 2018

Antimicrob Resist Infect Control

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BackgroundInfections caused by multi-drug resistant gram-negative bacterial infections are the principle threats to the critically ill patients of intensive care units. Increasing reports of these infections from the Nepalese intensive care unit underline the clinical importance of these pathogens. However, the impact of these infections on the patient’s clinical outcome has not yet been clearly evaluated. The objective of our study was to determine the incidence and associated clinical outcome of multi-drug resistant gram-negative bacterial infections in intensive care unit from a tertiary care center of Nepal.MethodsA prospective cohort study was conducted among adult patients admitted in intensive care unit of B. P Koirala Institute of Health Sciences from July to December 2017. Patients infected with multi-drug resistant gram-negative bacteria, non-multi-drug resistant gram-negative bacteria and those without infection were included. Identification of gram-negative bacteria and their antibiotic susceptibility pattern was performed with standard microbiological methods. Demographic, clinical profiles and outcomes (in-hospital-mortality, intensive care unit and hospital length of stay) were documented.ResultsThe incidence rate of multi-drug resistant gram-negative bacteria infections was 47 per 100 admitted patients (64/137) with 128 episodes. Acinetobacter species (41%, 52/128) was the commonest followed by Klebsiella pneumoniae (28%, 36/128) and Pseudomonas spp (21%, 27/128). Patients with multi-drug resistant gram-negative bacteria in comparison to non-multi-drug resistant gram-negative bacteria had high healthcare-associated infections (95%, 61/64 versus 20%, 2/10; p = < 0.001). In-hospital-mortality was 38% (24/64), 20% (2/10) and 10% (4/41) in multi-drug resistant, non-multi-drug resistant and uninfected group respectively (p = 0.007). After adjustment for independent risk factors, compared to uninfected patients, the odds ratio (CI) for in-hospital-mortality in multi-drug resistant and non-multi-drug resistant group was (4.7[1.4–15.5], p = 0.01) and 2.60 [0.38–17.8], p = 0.32) respectively. Multi-drug resistant patients also had longer intensive care unit and hospital stay, however, it was statistically insignificant.ConclusionThe incidence of multi-drug resistant gram-negative bacterial infections was remarkably high in our intensive care unit and showed a significant association with healthcare-associated infections and in-hospital-mortality.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal- a prospective cohort study

Siwakoti

Subedi

Sharma

et al. 2018

Antimicrob Resist Infect Control

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“…The global scenario shows gram positive infections to be predominant in western ICU, while gram negative pathogens are more prevalent in Indian ICUs. 28 However, variations within the health care community (rural/urban), healthcare set up (government/private) and wards of the hospital (various wards in a hospital) lead to various infections caused by different pathogens. Therefore, this makes it vital for the physicians to combine antibacterial agents covering both gram positive and gram negative pathogens.…”

Section: Discussionmentioning

confidence: 99%

Current clinical trends in the management of gram positive infections in Indian critical care settings: a survey

Rampal¹,

Ahdal²,

Kaushik³

et al. 2019

Int J Res Med Sci

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Background: In India, gram-positive infections (GPIs) particularly, methicillin-resistant Staphylococcus aureus (MRSA) prevalence is reported to increase exponentially. The overall mortality rate among patients with multi drug resistant GPIs in ICU setting are as high as 16%, despite the availability of various therapeutic options. Aim of the study is to determine the burden of GPIs in critical care settings and to understand the practising behaviour among the specialists in the management of MRSA infections.Methods: The survey was conducted among 264 critical care specialists who attended the Annual National Conference of Indian Society of Critical Medicine held in February 2019 at Mumbai. The delegates were administered a validated 10 question survey.Results: In the survey, 72% of the respondents agreed to the rising prevalence of MRSA and associated increased mortality rate of >16%. Empirical gram positive cover is being given to 30-40% of ICU patients, with ABSSSI being listed as a major indication followed by CAP, VAP, CLABSI and DFI. 46% of the doctors listed vancomycin as their preferred anti-MRSA agents followed by teicolplanin and linezolid. However, more than 80% of the doctors feel that nephrotoxicity in vancomycin, thrombocytopenia in linezolid and poor biofilm penetration are major limitations of these anti-MRSA agents.Conclusions: The survey highlighted the increasing trend in the prevalence and associated mortality in GPIs in critical care settings in India. Further, the limitations of existing anti-MRSA agents have invoked the need for a newer agent with a broad spectrum anti-bacterial activity along with improved safety profile and effective biofilm penetration, which can be used as a suitable alternative empiric therapy to manage GPIs.

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“…While Gram-positive infections are more prevalent in ICUs of western countries, the Indian ICUs are more commonly infected with Gram-negative organisms showing a high degree of antimicrobial resistance, as depicted in our study as well. 27 Therefore, blindly following the standard antimicrobial guidelines, which are mostly developed, based on research and evidences from western countries, may fail to provide the optimum results in India.…”

Section: Microbial Resistance Against Commonly Used Amasmentioning

confidence: 99%

Study of resistance pattern of isolated micro-organisms towards commonly used anti-microbial agents in medical intensive care unit of a tertiary care teaching hospital

Biswas

Rege

Karnik

et al. 2019

Int J Basic Clin Pharmacol

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Background: The objective of the study was to find out different types of biological samples from admitted patients tested for culture and sensitivity (C&S), prevalence of different types of organisms isolated from those samples, and to analyze the resistance pattern of those isolated organisms against commonly used or tested anti-microbial agents (AMAs).Methods: Following institutional ethics committee approval and written informed consent, adult patients of both genders, receiving AMAs were enrolled from June 2014 to July 2015 and followed up daily till they were in medical intensive care unit (MICU). Demographic data, diagnosis, culture-sensitivity (antibiogram) and other investigation reports and treatment details were recorded. Descriptive statistical analysis of collected data was done.Results: Of the 514 samples (from 600 patients enrolled) sent for C&S testing, 143 were reported as sterile while from the rest 371 samples, 504 organisms were isolated; commonly isolated organisms were Pseudomonas aeruginosa (30%), Acinetobacter baumannii (23%), Klebsiella pneumoniae (16%), Providencia sp. (7.1%), Escherichia coli (5.7%), and Enterobacter sp. (4.2%). Samples were sent in 63% of enrolled patients, the commonest being broncho-alveolar lavage (48% of total). Microbial resistance was high for cephalosporins (ceftriaxone, cefepime, ceftazidime), carbapenems (meropenem, imipenem), penicillins (piperacillin), quinolones (ciprofloxacin, levofloxacin), aminoglycosides (gentamicin, netilmicin, amikacin) and cotrimoxazole. Most organisms were sensitive to colistin (100%), polymyxin B (92%) and tigecycline (69%).Conclusions: The information regarding commonly isolated organisms and their resistant pattern would aid in rational selection of AMAs and thus the present study is useful to clinicians managing MICU and the hospital infection committee to plan future policies regarding AMA use in MICU.

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Intensive care unit bugs in India: How do they differ from the Western world?

Cited by 34 publications

References 0 publications

Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal- a prospective cohort study

Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal- a prospective cohort study

Current clinical trends in the management of gram positive infections in Indian critical care settings: a survey

Study of resistance pattern of isolated micro-organisms towards commonly used anti-microbial agents in medical intensive care unit of a tertiary care teaching hospital

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