Hospital acquired infections in Intensive Care Unit: A study on incidence, antibiotic resistance profile and outcome of the patients in a tertiary care unit in Eastern India.

Abstract

Hospital acquired infections (HAI) are the most common cause of mortality among critically ill patients because of various predisposing factors such as co-morbidities (medical or surgical), invasive devices, a long-term stay in the Intensive Care Unit (ICU), and the use of broad-spectrum empirical antibiotics. HAI in ICUs include mainly four types of infections: Catheter-related bloodstream infection (CRBSI), ventilator-associated pneumonia (VAP), catheter-related urinary tract infection (CAUTI), and surgical site infections (SSI). In this study, we aimed to characterise the bacteriological andantibiotic resistance profiles of all types of HAI along with their outcomes in the ICU of a tertiary care hospital in Eastern India. Patients included in this study were all critically ill patients aged above 12 years who had one or more devices inserted and were admitted in the ICU due to some medical or surgical complication for more than 48 hours. This was a prospective study for a period of three months. Appropriate specimens were collected from admitted patients suspected of having infections for identification and antibiotic susceptibility testing. The outcomes were determined based on either the discharge of the patient, a transfer to a separate ward, or death within the hospital. A total of 169 patients were included in the study, of which 65 patients (38%) acquired an HAI in the ICU. Thirteen patients were diagnosed with multiple types of infections. There were 72 device related infections, of which CRBSI made up 36%, VAP made up 23%, CAUTI made up 20%, and SSI made up 21% of the total patients. The most isolated organism in the ICU setup was Klebsiella spp. (35%), followed by Enterococcus spp. (22%). We found that 92% of the Klebsiella spp. was resistant to Carbapenem and 30% were Vancomycin-Resistant Enterococcus (VRE). The highest mortality was found associated with VAP (73%), followed by CRBSI (52%), SSI (40%), and CAUTI (31%) in the ICU setting. The findings of this study are of great clinical importance and will help in preventing and controlling the spread of HAIs in the ICU.