Characterization of hospital acquired infections in teritaty care teaching hospital, Kathmandu

Abstract

Background: Hospital acquired infections (HAIs) are the most frequent adverse event in health-care delivery worldwide. Emergence of antibiotic resistance has in turn complicated the therapeutic process, thereby increasing morbidity, mortality, length of hospital stay and treatment costs. This study aims to determine the rate of hospital acquired infection, its characterization and risk factors associated with acquisition of HAIs Methods and materials: This cross sectional study was conducted over period of 6 m. A total of 176 clinical specimens from patients admitted for >48 h and suspected hospital acquired infection were processed and bacterial isolates were identified using standard microbiological methods. Antimicrobial susceptibilities of the isolates were determined according to the CLSI guidelines and β-lactamases (ESBL, MBL, KPC and AmpC), MRSA and iMLSB were detected by phenotypic methods. Correlation between HAIs and risk factors were determined using Pearson's Chi-Square test and odds ratio (OR) by using binary logistic regression. Results: Among 176 specimens, 51(28.9%) showed significant bacterial growth with 57 bacterial isolates. Pneumonia (49%) was the most common infection site followed by Surgical site infection(21.5%), Urinary tract infection(11.5%). Acinetobacter spp. Escherichia coli, and Staphylococcus aureus, were the leading bacterial isolates. Multi Drug Resistance was observed in 93% isolates along with 41.5% ESBL, 56.1% MBL, 39% KPC, 24% AmpC β-lactamase among Gram Negative isolates and 83.3% MRSA and 7.7% iMLSB producer among Staphylococcus isolates. Independent risk factors for acquisition of HAIs were ICU stay (OR,2.34), hospital stay for >6 d (OR,3.58), surgery (OR,2.11), urinary catheterization (OR,2.18), mechanical ventilation (OR,3.61), NG intubation (OR,4.395), central venous catheterization (OR,4.42), ET intubation (OR,5.23), Diabetes Mellitus (OR,5.26), heart disease (OR,3.16), and hypertension (OR,2.295). Conclusion: High incidence of HAIs was observed in our study with majority being caused by MDR pathogens. Continuous surveillance of drug resistance, development of infection control protocols and treatment protocols in accordance to the patient's characteristics with strict implementation is highly recommended.