English

Abstract

BACKGROUND Lower respiratory tract infections are the most common bacterial infections in neurosurgery intensive care units (NSICU), resulting in high overall mortality. The emergence of antibiotic resistant pathogens poses a challenge to their empiric treatment. Regular surveillance of the prevalent strains and their susceptibility pattern, helps to revise the antibiotic policies and aids in better management of the patient. METHODS A cross sectional study was conducted in the Department of Neurosurgery and Microbiology, Government Medical College, Thrissur, over a period of 1 year, using lower respiratory tract specimens of 190 patients with acute respiratory symptoms admitted in neurosurgery intensive care unit. The specimens collected aseptically were processed immediately. Following culture, the bacterial isolates were identified using standard methods and antibiotic susceptibility was done by Kirby Bauer disc diffusion method. The data obtained was coded and entered in Microsoft Excel and expressed as percentage. RESULTS Bacterial isolates were obtained from 74 % samples. 82 % isolates were monomicrobial and 18 % were polymicrobial. Majority of the isolates were gram negative bacteria (94 %) followed by gram positive bacteria (6 %). The common gram-negative isolates were K. pneumoniae (36 %), A. baumannii (29 %), P. aeruginosa (20 %). Methicillin-resistant staph (MRSA) (3 %) and methicillinsusceptible staph (MSSA) (3 %) accounted for the gram positive cocci. 61 % isolates were multi drug resistant (MDR). Most common MDR organism was A. baumannii. It was observed that 26 % isolates were extended spectrum betalactamase (ESBL) producers. A high rate of resistance to cephalosporins, beta lactams, fluoroquinolones, aminoglycosides, and cotrimoxazole was observed. An emerging resistance to carbapenems was observed. CONCLUSIONS Proper microbiological work up and antibiotic stewardship programmes can limit spread of resistant organisms, thereby reducing the medical and economic burden of the patient. KEYWORDS Lower Respiratory Tract Infection, Neurosurgery ICU, Antimicrobial Susceptibility Tests, Multi Drug Resistant Organisms