Epidemiology and Clinical Outcome of Common Multi-drug Resistant Gram-negative Bacterial Infections in a Network of Hospitals in India (IMPRES): A Multicenter Intensive Care Unit-based Prospective Clinical Study.

Abstract

Background and aims: India witnessed the exponential rise of antibiotic resistance due to the high burden of communicable disease. The Indian Council of Medical Research reported Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumoniae (PEAK organisms) as the most common gram-negative isolates, constituting 65.5% of total isolates. The present study aimed to observe the demographics and clinical outcomes of patients infected with these four common gram-negative bacteria in ICUs across India.

Patients and methods: This prospective multicentric observational study was conducted in ICUs of 19 hospitals across India. The data collected for each patient included: demography, diagnosis, disease severity score, site of infection, PEAK organism, risk factors for multidrug resistance, antibiotic sensitivity, resistance pattern, total ventilator days, and 28-day mortality. Subgroup analysis of 28-day mortality was done for community-acquired vs hospital-acquired infection, appropriate empirical antibiotic, Carbapenem- and Colistin-resistant infections.

Results: A total of 936 patients were included in the analysis. Resistance to Cephalosporin, Fluroquinolones, Piperacillin Tazobactam, Carbapenem, Aminoglycosides, and Colistin was observed in 84, 68, 55, 47, 37, and 4.2% of patients, respectively. The 28-day crude mortality rate was 23.5%, which was higher in the subgroup with isolates resistant to empiric antibiotics compared to those with sensitive isolates (29.6 vs 21.4%, p > 0.05). Moreover, 32 and 27% mortality rates were observed in patients who were infected with Carbapenem-resistant and Colistin-resistant PEAK organisms, respectively.

Conclusion: The present study observed a high prevalence of antibiotic resistance in Indian ICUs, contributing to a crude mortality rate of 23.5%. Patients with Carbapenem and Colistin resistance may exhibit higher 28-day crude mortality.

How to cite this article: Das SK, Joshi Z, Govil D, Shah MS, Jakaraddi GN, Sinha S, et al. Epidemiology and Clinical Outcome of Common Multi-drug Resistant Gram-negative Bacterial Infections in a Network of Hospitals in India (IMPRES): A Multicenter Intensive Care Unit-based Prospective Clinical Study. Indian J Crit Care Med 2025;29(6):504-509.CTRI identifier: CTRI/2023/01/049121.