BACTERIAL SUSCEPTIBILITY PATTERNS OF PATHOGENS IN ICU IN TERTIARY CARE.

Abstract

Introduction: Globally antibiotic resistant pathogens are encountered in Intensive Care Unit (ICU). ICU plays important role in the management of critically ill patients and treatment of the infections. In ICU antibiotics susceptibility and resistance play an important role in the management of infection. Emergence of the antibiotic resistance is becoming increasingly difficult problem in ICU. In ICU, nosocomial infections with multi-drug resistant strains are becoming important cause of morbidity and mortality compared with an average patient. The source for multi-drug resistant bacteria may include repeated use of higher antibiotics, poor hand hygiene, reuse of items used for individual patients, lack of environmental cleaning, resource management and education and surveillance. Aim: To know prevalence of the drug resistance patterns for the patients admitted in ICUs. Material and Methods: The study was done on 106 isolates from ICU of 40 patients. It was conducted at the Department of Medicine Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai. Sample for the culture were taken from ICU patients, depending upon the infections like sepsis, ventilator associated pneumonia, respiratory tract infection and post-operative patients. Multiple samples from different sites as well as in different times were taken from the patient having multiple infections. Specimens like blood, urine, pus and CSF etc. were taken depending upon the type of infection. Samples were received in the microbiology laboratory for the culture in sterile universal container. Initially strains were identified based on the morphological behaviour of the isolates on various differential media. Results In vitro susceptibility data of 106 isolates from ICU were analysed.  Among 106 isolates from 40 patients 25(62.5%) males and 15 (37.5%) females with age ranging from 20 years to 90 years (average 55 years) were studied. Out of 106 isolates 86(81.14%) were Gram negative organisms and 20(18.86%) were Gram positive organisms. Among all Gram positive organism 13(65%) were Staphylococcus aureus. The most frequent species isolated from infections in ICU was E.coli , followed by Pseudomonas spp, Klebsiella spp, Acinetobacter spp, Enterococcus, Proteus mirabilis and Providencia spp which were 18.87%, 16.03%, 16.03% ,12.26%, 6.60%, 1.89%  and 0.94% respectively. 25(23.58%) were ESBL producer out of all isolates and 29.07% out of total Gram negative organism. Conclusion This study concludes that gram negative organisms are causing more infections than gram positive organisms in ICU patients. E.coli was the most common organism isolated and shows high resistance to Amoxcillin+Clavulanic acid and Ciprofloxacin. Enterococcus was found to be resistant to Erythromycin and Penicillin. Thus, Gram negative organisms are more resistant to higher antibiotics. Antibiotics should be used carefully. Therefore, antibiotic policies should be formed for ICU and other critical care facilities.

Keywords: ICU, Antibiotics, ESBL, Staphylococcus aureus