Abstract
The increasing emergence of Acinetobacter spp. with healthcare associated infections (HCAI) in intensive care units (ICU) is alarming. This study was a laboratory-based audit to determine the prevalence of Acinetobacter spp. associated with HCAI in the adult ICU of a tertiary care hospital in Varanasi, north India, with special reference to antimicrobial resistance and resistance determinants over a period of 5 years. A total of 993 cases of HCAI were analyzed. Isolates were characterized as multidrug resistance and extended drug resistance (MDR/XDR) based on antimicrobial susceptibility records. Few (100) randomly selected isolates of Acinetobacter baumannii (A. baumannii) were tested for imipenem, meropenem, and polymyxin B susceptibility by minimum inhibitory concentration (MIC) and for the presence of class A and B carbapenemases by multiplex PCR. Active surveillance of ICU environment was also performed. High prevalence of Acinetobacter related hospital acquired pneumonia (HAP) with significant resistance to imipenem (p<0.05) and 88.02% MDR and 61.97% XDR was detected along with persistence in the ICU environment. The isolates harbored blaIMP (89%), blaVIM (51%), blaNDM-1 (34%), and blaOXA-23-like (93%) genes. Specific interventional measures should be adopted to control these imipenem resistant Acinetobacter spp. which have attained the level of endemicity in our ICU setup.
Highlights
The intensive care unit (ICU) in a hospital is a unique setting having both patients with compromised immune status and conditions conducive to the growth of microorganisms
With worldwide reports of increasing isolation of this organism from the ICU, we performed a laboratory-based audit of healthcare associated infections (HCAI) with special reference to Acinetobacter spp. to estimate the extent of the problem in the adult ICU of the tertiary care hospital and analyze the prevalent situation for possible control measures
A total of 2984 samples from same number of patients were considered with clinical evidence of HCAI
Summary
The intensive care unit (ICU) in a hospital is a unique setting having both patients with compromised immune status and conditions conducive to the growth of microorganisms On one hand it houses critically ill patients, while at the same time it provides a suitable environment for proliferation and persistence of several multidrug resistant organisms (MDROs) amidst high antibiotic pressure [1]. Several factors like over the counter antibiotic use, overcrowding in hospitals, imperfect infection control practices, and use of excessive invasive devices contribute to the development of high antimicrobial resistance, especially in developing countries [2] These factors facilitate easy transmission of MDROs implicated in various healthcare associated infections (HCAI). With worldwide reports of increasing isolation of this organism from the ICU, we performed a laboratory-based audit of HCAI with special reference to Acinetobacter spp. to estimate the extent of the problem in the adult ICU of the tertiary care hospital and analyze the prevalent situation for possible control measures
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