Clinical profile, bacterial profile and outcomes in an intensive care unit of a tertiary care hospital in south India: one year study

Abstract

Background: Infections still remain as one of the major cause of mortality in low and lower- middle-income countries as reported by Global Burden of Diseases study. Intensive care units (ICU) are a major source of infections in tertiary care hospitals. Widespread multi-drug resistant gram positive and gram negative bacterial isolates are also associated with infections in ICU. A hospital based epidemiological study was to determine the risk factors; bacterial isolates, antibiotic sensitivity and outcomes in ICU patients.Methods: This prospective study was done at Narayana Medical College and Hospital for 12 months from 1st February 2015 to 31st January 2016. All the risk factors were noted. Patient’s outcome noted as death, recovery and transfer to palliative care. Data entry and analysis performed in Microsoft excel, p valve < 0.001 was considered significant.Results: Three hundred and thirty patients were included in the study (age: 56.16±15 years, 57.6% males). 159 (48.2%) were direct admissions, 103 (31.2%) were transfers from other hospitals. Major cause of admission was neural (29.1%) followed by cardiovascular (21.8%). HTN (52.4%) was major co-morbidity followed by type-2 DM (47.3%). 51.9% culture positivity (n = 539) was observed with sputum 83.6% and blood 24.2%. Gram-negative pathogens were predominant which includes Acinetobacter baumanii (13.8%), Escherichia coli (20%), Klebsiella pneumoniae (14.3%), Pseudomonas aeruginosa (9%), Enterobacter aerogenes (5.1%). Candida Sp and MRSA, VRE were isolated. In the study 255(77.3%) recovered, 38(11.5%) progressed to death and 37(11.2%) transferred to palliative care. Higher mortality was noticed with Acinetobacter baumani (81.6%).Conclusions: High prevalence of gram-negative bacterial infections and multi-drug resistant isolates was noted in Indian ICUs.