Abstract
Hospital-acquired bloodstream infections (BSIs) cause high mortality in the intensive care units (ICUs) compared to wards. Furthermore, the isolation of multidrug resistant (MDR) organisms in ICUs add to the gravity of the condition making the treatment a bigger challenge. The present study was aimed to evaluate the prevalence, spread, and the possible MDR organisms contributing to ICU-acquired BSI & the source of the secondary BSI in the ICUs. A prospective study was conducted in four ICU of tertiary teaching hospital over a period of six months. Patient that developed features of BSI within 48 hours after hospital admission were included in the present study Blood culture was performed by an automated BacT/ALERT®3D system. The source of secondary BSI was identified by analysing culture results for the samples other than blood. These samples were taken within 48 hours of the patient’s blood culture test being positive. A total of 50 patients (25%) had an ICU acquired bloodstream infection. Out of 50 patients, 74% of them had bacterial etiology. Thirty one patients (62%) among them developed multidrug resistant bacteraemia. Fifty six percent of Gram negative bacilli were multi drug resistant. The resistance to carbapenem was 42%. The most common MDR Gram negative isolate was identified as Klebsiella pneumoniae (n=12; 38.7%,) and the most common source was pulmonary infection (26.7% (n=12). 42% of isolates in our study were carbapenem resistant suggesting the need for a proper antibiotic policy in the ICUs. Prolonged stay in the ICU with mechanical ventilation was the critical risk factor and ICU mortality was high (38%).
Highlights
Patients in intensive care units (ICUs) are at greater risk of developing nosocomial infections[1]
Age (Mean ± SD, Range) Male Female ICU stay in days (Mean ± SD) Hospital stay in days (Mean ± SD) Underlying Co-morbid conditions: Diabetes Chronic Renal disease Cardiovascular disease Chronic liver disease Chronic lung disease Malignancy Neutropenia Exposure to invasive devices Mechanical Ventilation No of patients n (%) Duration of exposure (Mean± SD) Urinary Catheter No of patients Duration of exposure (Mean± SD) Central venous catheter(CVC) No of patients Duration of exposure (Mean± SD)
The present study evaluated the etiological agents, antimicrobial susceptibility pattern, and source of secondary Bloodstream infections (BSIs) acquired in intensive care of a tertiary care hospital
Summary
Patients in intensive care units (ICUs) are at greater risk of developing nosocomial infections[1] This problem is more in developing countries, largely due to lack of strict adoption of efficient infection control practices. Bloodstream infections (BSIs) represent a major class of hospital acquired infection prevalent in ICU patients. The fatality rate can range from 35-50% further adding to the complexity[4] It may present itself as primary BSI or a secondary BSI from an already existing source of infection in the patient[5]. BSIs acquired in the ICUs are due to drug-resistant hospital strains like Acinetobacter baumanii, K. pneumoniae, P. aeruginosa, S. aureus etc. These MDR pathogens increase the mortality rate, length of stay in the ICU, and generate substantial extra costs[6]. Due to the lack of information in this area in the current study population, the study is being conducted to know the etiological agents of ICU acquired BSIs, their antibiotic susceptibility pattern, and the source of the pathogen to guide appropriate antimicrobial treatment
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