Multicenter observational study to evaluate epidemiology and resistance patterns of common intensive care unit-infections

Abstract

Background:There is limited data regarding the microbiology of Intensive Care Unit (ICU)-acquired infections, such as ventilator-associated pneumonia (VAP), catheter-associated urinary tract infections (CAUTI), and catheter-related bloodstream infections (CRBSI) from India.Objectives:To explore the microbiology and resistance patterns of ICU-acquired infections and evaluate their outcomes.Materials and Methods:This was a multicenter observational study, conducted by Indian Society of Critical Care Medicine (MOSER study) between August 2011 and October 2012. Patients in the ICU ≥48 h with any ICU-acquired infection within 14 days of index ICU stay were included. Patient demographics, relevant clinical, and microbiological details were collected. Follow-up until hospital discharge or death was done, and 6-month survival data were collected.Results:Of the 381 patients included in the study, 346 patients had 1 ICU infection and 35 had more than one ICU infection. Among patients with single infections, 223 had VAP with Acinetobacter being the most common isolate. CAUTI was seen in 42 patients with Klebsiella as the most common organism. CRBSI was seen in 81 patients and Klebsiella was the most common causative organism. Multidrug resistance was noted in 87.5% of Acinetobacter, 75.5% of Klebsiella, 61.9% of Escherichia coli, and 58.9% of Pseudomonas isolates, respectively. Staphylococcus constituted only 2.4% of isolates. Mortality rates were 26%, 11.9%, and 34.6% in VAP, CAUTI, and CRBSI, respectively.Conclusion:VAP is the most common infection followed by CRBSI and CAUTI. Multidrug-resistant Gram-negative bacteria are the most common organisms. Staphylococcus aureus is uncommon in the Indian setting.

Inhospital death is a biased measure of fatal outcome from bloodstream infection

“…Among these, one-half only evaluated inhospital outcomes including two studies that restricted to intensive care unit (ICU) outcome alone16,17 with the other three limited to inhospital death 18–20. The other one-half of studies evaluated 30-day,21,22 90-day,23,24 and 6-month25 all-cause deaths. We chose BSI to study this issue as a matter of convenience as we had ready access to a detailed population-based database.…”

A multicentric, prospective, observational antibacterial utilization study in Indian tertiary referral centers

“…Patients admitted to the medical intensive care unit (MICU) of tertiary referral centers are critically ill and incidences of nosocomial infections are also very high. [ 1 2 ] Antibacterial agents are the most prescribed drugs for rapid control of serious infections to reduce the mortality and morbidity. [ 2 3 4 ] The burden of bacterial disease in India is among highest in the world and the inappropriate use of antibacterial agents leads to increase the development of antibacterial resistance.…”

“…[ 2 3 4 ] The burden of bacterial disease in India is among highest in the world and the inappropriate use of antibacterial agents leads to increase the development of antibacterial resistance. [ 1 5 6 ] Antibiotic resistance has been a low-priority area in most developing and many developed countries. To overcome the burden of infectious disease and rising antibiotic resistance prevalence in India, the Global Antibiotic Resistance Partnership-India Working Group have recommended important interventions which include surveillance of antibiotic use, distributing standard treatment guidelines, increasing the use of diagnostics tests, infection control interventions, educational approaches, and improving antibiotic supply chain and quality.…”

Antimicrobial Resistance Patterns in Clinically Significant Isolates from Medical Wards of a Tertiary Care Hospital in North India

“…We observed a predominance of Gram-negative pathogens (92% of 323 culture-positive isolates) in our study, which is different from what is reported from western studies. 10 11 The spectrum of microorganisms responsible for infections in medical ICUs and wards has been reported to be different in western world in comparison to Indian subcontinent. 12 13 The reason for the same is not fully known, albeit, some believe that this may be due to difference in the climatic condition.…”